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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.01  Expand sub section  Positive inotropic drugs
02.01.01  Expand sub section  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  Expand sub section  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  Expand sub section  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  Expand sub section  Diuretics to top
02.02.01  Expand sub section  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.
 
 
Metolazone (Xaqua®)
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Alternatives
Green plus
 
Link  MHRA Drug Safety Update (Jan 2023): Xaqua (metolazone) 5mg tablets: exercise caution when switching patients between metolazone preparations
 
Chlorothiazide 250mg in 5ml suspension
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Unlicensed Drug Unlicensed
Green plus
  • Treatment should only be on advice from paediatric cardiology or nephrology specialists
 
 
02.02.02  Expand sub section  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  Expand sub section  Potassium-sparing diuretics and aldosterone antagonists
Amiloride Hydrochloride
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First Choice
Green
 
Finerenone (Kerendia®)
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Formulary
Green plus
  • Approved as an option for treating stage 3 and 4 chronic kidney disease (with albuminuria) associated with type 2 diabetes in adults - in line with NICE TA877:
    • add-on to optimised standard care; this should include, unless they are unsuitable, the highest tolerated licensed doses of:
      • angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) and
      • sodium–glucose cotransporter‑2 (SGLT2) inhibitors and
    • the person has an estimated glomerular filtration rate (eGFR) of 25 ml/min/1.73 m2 or more.
 
Link  NENC - Finerenone for treating chronic kidney disease in people with type 2 diabetes
Link  NICE TA877: Finerenone for treating chronic kidney disease in type 2 diabetes
 
02.02.03  Expand sub section  Aldosterone antagonists
Spironolactone
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Formulary
Green
  • Green Resistant Hypertension - Step 4 NICE NG 136 - consider seeking expert advice
  • Green plus Post-acute myocardial infarction patients and patients with heart failure treatment should be initiated on instructions from a cardiologist or GP with a specialist interest in cardiology. Spironolactone is first choice (ahead of eplerenone) for severe heart failure.
  • Spironolactone 10mg and 50mg in 5ml suspension is also approved unlicensedunlicensed.
  • 50mg/5ml - Recommended strength in children as per NPPG/RCPCH Position Statement: Using Standardised Strengths of Unlicensed Liquid Medicines in Children
 
Link  MHRA Drug Safety Update (Dec 2016): Spironolactone and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia—clarification, December 2016
Link  MHRA Drug Safety Update (Feb 2016): Spironolactone and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia.
Link  RCPCH Position Statement: Using Standardised Concentrations of Liquid Medicines in Children
 
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 NG106: Chronic heart failure in adults: diagnosis and management
 
02.02.04  Expand sub section  Potassium-sparing diuretics with other diuretics to top
Spironolactone and chlorothiazide capsules
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

 
 
02.02.05  Expand sub section  Osmotic diuretics
Mannitol
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Formulary
Red
 
 
02.02.06  Expand sub section  Mercurial diuretics
02.02.07  Expand sub section  Carbonic anhydrase inhibitors
02.02.08  Expand sub section  Diuretics with potassium
02.03  Expand sub section  Anti-arrhythmic drugs to top
Magnesium Sulphate Injection
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Formulary
Red
 
Link  MHRA Drug Safety Update (May 2019): Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy
 
02.03.01  Expand sub section  Management of arrhythmias
02.03.02  Expand sub section  Drugs for arrhythmias
02.03.02  Expand sub section  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).
 
 
02.03.02  Expand sub section  Supraventricular and ventricular arrhythmias
Amiodarone
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Formulary
  • 100mg & 200mg tablets Amber
  • 50mg in 5ml suspension is also approved Amber unlicensedunlicensed
  • 150mg/3ml & 300mg/10ml injection Red Traffic Light

NHS England (June 2019) advises that prescribers should not initiate amiodarone in primary care for any new patient.

in exceptional circumstances, where there is a clinical need for amiodarone to be prescribed, this should be undertaken in a cooperation arrangement with a multi-disciplinary team and/or other healthcare professional. Amiodarone has an important place in the treatment of severe cardiac rhythm disorders where other treatments either cannot be used or have failed. It has potential major toxicity and its use requires monitoring both clinically and via laboratory testing. 

MHRA Drug Safety Update (Mar 2022): Amiodarone (Cordarone X): reminder of risks of treatment and need for patient monitoring and supervision

 
Link  NENC Shared Care Protocol - Amiodarone for patients in adult services
 
Atenolol
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Formulary
Green
 
 
Flecainide
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Formulary
Green plus
  • 50mg & 100mg tablets
  • 5mg in 1ml liquid unlicensedunlicensed. 
 
 
Propafenone
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Formulary
Green plus
 
 
Disopyramide
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Formulary
Green plus
 
 
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  NENC Shared Care Protocol - dronedarone for patients in adult services
Link  NICE TA197 (Atrial fibrillation - dronedarone)
 
Flecainide Injection
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Formulary
Red
  • Injection: 150ml/15ml 
 
 
Mexiletine
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Formulary
Red

  • 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 plus
 
 
Ajmaline
Unlicensed Drug Unlicensed
Red
  • For use as a diagnostic test of Brugada syndrome.
 
 
02.03.02  Expand sub section  Ventricular arrhythmias to top
Lidocaine
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Formulary
Red
  • 100mg injection, pre-filled syringes
  • 1mg/ml (0.1%) & 2mg/ml (0.2%) IV infusions 500ml
 
 
02.04  Expand sub section  Beta-adrenoceptor blocking drugs
Atenolol
(Cardioselective)
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First Choice
Green
 
Propranolol
(non-cardioselective)
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First Choice
Green
 
Atenolol Injection
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Formulary
Red
  • 5mg/10ml injection
 
 
Labetalol Injection
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Formulary
Red
  • 50mg/10ml and 100mg/20ml
 
 
Metoprolol Injection
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Formulary
Red
  • Injection: 5mg/5ml 
 
 
Propranolol Injection
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Formulary
Red
 
 
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
  • Tablets: 50mg, 100mg, 200mg, 400mg
 
 
Metoprolol
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Alternatives
Green
  • Tablets: 50mg, 100mg
  • SR Tablets: 200mg 
 
 
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  Expand sub section  Drugs affecting the renin-angiotensin system and some other antihypertensive drugs
02.05.01  Expand sub section  Vasodilator antihypertensive drugs
Hydralazine
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Formulary
Green plus
  • Tablets - 25mg, 50mg
 
 
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. 
 
 
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
 
Epoprostenol
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Formulary
Red
High Cost Medicine
  • Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 
 
 
Hydralazine Injection
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Formulary
Red
  • Ampoules: 20mg
 
 
Iloprost
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Formulary
Red
High Cost Medicine
  • Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 
 
 
Macitentan
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Formulary
Red
High Cost Medicine
  • Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 
 
 
Riociguat
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Formulary
Red
High Cost Medicine
  • Approved for Chronic Thromboembolic Pulmonary Hypertension - in accordance with NHS England Commissioning policy. 
 
 
Sildenafil
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Formulary
  • 20mg tablets
  • 25mg, 50mg & 100mg tablets unlicensedunlicensed indication
  • Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. Red
  • Approved for systemic sclerosis with ongoing digital ulcer disease (to reduce number of new digital ulcers) - in accordance with NHS England Commissioning policy. Red
  • Approved for secondary Raynaud's Green plus

 

 
Link  MHRA Drug Safety Update (Nov 2018): Sildenafil (Revatio and Viagra): reports of persistent pulmonary hypertension of the newborn (PPHN) following in-utero exposure in a clinical trial on intrauterine growth restriction
 
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.
 
 
Treprostinil
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Unlicensed Drug Unlicensed
Red
  • Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 
 
 
02.05.02  Expand sub section  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 plus
 
 
Moxonidine
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Formulary
Green plus
 
 
02.05.03  Expand sub section  Adrenergic neurone blocking drugs to top
02.05.04  Expand sub section  Alpha-adrenoceptor blocking drugs
Doxazosin
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Formulary
Green
  • 1mg, 2mg & 4mg tablets
 
 
02.05.04  Expand sub section  Phaeochromocytoma
Phenoxybenzamine
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Formulary
Red
 
 
Phentolamine
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Formulary
Red
 
 
02.05.05  Expand sub section  Drugs affecting the renin-angiotensin system
02.05.05  Expand sub section  Heart Failure
02.05.05.01  Expand sub section  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
  • For use in breastfeeding mothers only. Breastfeeding mothers should be converted to ramipril when they are no longer breastfeeding. 
 
 
Perindopril erbumine
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Alternatives
Green

  • Perindopril is third line for all indications including prevention of stroke.

  • Note: Perindopril arginine is Non-Formulary.

 
Link  Items not to be routinely prescribed in primary care
 
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  Expand sub section  Angiotensin-II receptor antagonists
Losartan
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First Choice
Green
  • To be used as first line treatment in all new 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  Expand sub section  Renin inhibitors
02.06  Expand sub section  Nitrates, calcium-channel blockers, and potassium-channel activators
02.06  Expand sub section  Angina
02.06.01  Expand sub section  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.

 

 
 
Glyceryl Trinitrate Injection
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Formulary
Red
  • 5mg in 5ml , 50mg in 10ml & 50mg in 50ml injections 

 

 
 
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  Expand sub section  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.
 
Felodipine
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Formulary
Green
  • M/R tablets: 2.5mg, 5mg, 10mg 
 
 
Nimodipine Injection
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Formulary
Red
  • 10mg in 50ml for IV infusion 
 
 
Verapamil Injection
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Formulary
Red
  • Injection: 5mg/2ml (2.5mg/1ml) 
 
 
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
  • Tablets - 40mg, 80mg, 120mg, 160mg
  • MR Tablets - 240mg
  • Oral Solution - 40mg/5ml
 
 
Nimodipine
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Alternatives
Green plus
  • 30mg tablets - treatment should be on the advice of the stroke team or a cardiologist.
 
 
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  Expand sub section  Other anitanginal drugs
Nicorandil
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Formulary
Green
 
Link  MHRA Drug Safety Update (Jan 2016): Nicorandil (Ikorel): now second-line treatment for angina - risk of ulcer complications
 
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  MHRA Drug Safety Update (Dec 2014): Ivabradine (Procoralan) in the symptomatic treatment of angina: risk of cardiac side effects
Link  NICE TA267: 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  Expand sub section  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  Expand sub section  Other preparations used in peripheral vascular disease
02.07  Expand sub section  Sympathomimetics to top
02.07.01  Expand sub section  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  Expand sub section  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
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  Expand sub section  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  Expand sub section  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  Expand sub section  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  Expand sub section  Heparin
Heparin
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Formulary
Red
 
 
02.08.01  Expand sub section  Low molecular weight heparins
Tinzaparin
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First Choice
Green plus
 
Enoxaparin (Inhixa®)
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Restricted Drug Restricted
Green plus
  • approved for use in the treatment of acute coronary syndromes
  • VTE prophylaxis 

 

 
Link  Shared Care Guideline (CUMBRIA ONLY) - Low Molecular Weight Heparin (LMWH) - Enoxaparin
 
02.08.01  Expand sub section  Heparinoids
Danaparoid
View adult BNF View SPC online View childrens BNF
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  Expand sub section  Hirudins
Bivalirudin
View adult BNF View SPC online View childrens BNF
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 NG185: Acute coronary syndromes
 
02.08.01  Expand sub section  Heparin flushes to top
Heparin
(Flush)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 50 units in 5ml & 200 units in 2ml – for flushing cannulae
 
 
TauroHep®
(Taurolidine and citrate catheter lock solution with heparin)
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)
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  Expand sub section  Epoprostenol
Epoprostenol
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • For pulmonary hypertension see section 2.5.1 
 
 
Iloprost
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Mainly for use in treating pulmonary hypertension - see secton 2.5.1 
 
 
02.08.01  Expand sub section  Fondaparinux
Fondaparinux
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved for high risk orthopaedic surgery pateints and as an alternative to enoxaparin in accordance with NICE guidance.
 
Link  Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
 
02.08.02  Expand sub section  Oral anticoagulants
 note 

NHSE Operational note: Commissioning recommendations for national procurement for direct-acting oral anticoagulant(s) (DOACs)

County Durham and Darlington DVT Pathway Information

Tees Warfarin Guidelines for Primary Care

Warfarin
View adult BNF View SPC online View childrens BNF
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.
 
Link  MHRA Drug Safety Update (July 2016): Warfarin: reports of calciphylaxis
Link  MHRA Drug Safety Update (Oct 2020): Warfarin and other anticoagulants: monitoring of patients during the COVID-19 pandemic
 
Phenindione
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Acenocoumarol (Sinthrome®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 1mg tablets
 
 
Andexanet alfaBlack Triangle (Ondexxya®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red

 

    • 200mg powder for solution for infusion

 

    • Approved for reversing anticoagulation from apixaban and rivaroxaban in adults with life-threatening or uncontrolled bleeding in line with NICE

 

 
Link  NICE TA697: Andexanet alfa for reversing anticoagulation from apixaban or rivaroxaban
 
Apixaban
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults
Link  NICE TA275: Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation
Link  NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
Link  MHRA Drug Safety Update Dec 2014: New oral anticoagulants apixaban (Eliquis▼), dabigatran (Pradaxa) and rivaroxaban (Xarelto▼)
Link  MHRA Drug Safety Update June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  MHRA Drug Safety Update June 2020: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, including availability of reversal agents
 
Dabigatran
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Only approved for use in accordance with NICE guidance. 
 
Link  MHRA Drug Safety Update Dec 2014: Dabigatran (Pradaxa): contraindicated in patients with prosthetic heart valve(s) requiring anti-coagulant treatment
Link  MHRA Drug Safety Update Dec 2014: New oral anticoagulants apixaban (Eliquis▼), dabigatran (Pradaxa) and rivaroxaban (Xarelto▼)
Link  MHRA Drug Safety Update June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  MHRA Drug Safety Update June 2020: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, including availability of reversal agents
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
Formulary
Green
  • Only approved for use in accordance with NICE guidance. 
 
Link  MHRA Drug Safety Update June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
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
 
RivaroxabanBlack Triangle
(For CAD/PAD)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 2.5mg tablets

 

  • Rivaroxaban co-administered with acetylsalicylic acid (ASA), is indicated for the prevention of atherothrombotic events in adult patients with coronary artery disease (CAD) or symptomatic peripheral artery disease (PAD) at high risk of ischaemic events.
  • Approved for use in accordance with NICE TA607
 
Link  MHRA Drug Safety Alert June 2020: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, including availability of reversal agents
Link  MHRA Drug Safety Update Dec 2014: New oral anticoagulants apixaban (Eliquis▼), dabigatran (Pradaxa) and rivaroxaban (Xarelto▼)
Link  MHRA Drug Safety Update July 2019: Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken with food
Link  MHRA Drug Safety Update June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  MHRA Drug Safety Update Oct 2018: Rivaroxaban (Xarelto▼) after transcatheter aortic valve replacement: increase in all-cause mortality, thromboembolic and bleeding events in a clinical trial
Link  NICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease
 
Rivaroxaban
View adult BNF View SPC online View childrens BNF
Formulary
Green

  • 2.5mg, 10mg, 15mg & 20mg tablets

  • 1mg/1ml granules for oral suspension

    • approved for the treatment of VTE in children



  • Only approved for use in accordance with NICE guidance. 

 
Link  MHRA Drug Safety Update Dec 2014: New oral anticoagulants apixaban (Eliquis▼), dabigatran (Pradaxa) and rivaroxaban (Xarelto▼)
Link  MHRA Drug Safety Update July 2019: Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken with food
Link  MHRA Drug Safety Update June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  MHRA Drug Safety Update June 2020: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, including availability of reversal agents
Link  MHRA Drug Safety Update Oct 2018: Rivaroxaban (Xarelto▼) after transcatheter aortic valve replacement: increase in all-cause mortality, thromboembolic and bleeding events in a clinical trial
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  Expand sub section  Stroke prevention in AF
02.08.02  Expand sub section  VTE treatment to top
02.08.02  Expand sub section  VTE prophylaxis in hip/knee surgery
02.08.02  Expand sub section  Antidotes
02.08.03  Expand sub section  Protamine sulphate
Protamine Sulphate
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
02.09  Expand sub section  Antiplatelet drugs
Aspirin
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 75mg dispersible tablets
  • Note: 75mg e/c tablets – no longer recommended for use.
 
 
Cangrelor (Kengrexal®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 50mg powder for concentrate for solution for injection/infusion
    • Approved for bridging therapy in patients who have recently had a coronary stent but require urgent elective surgery


 
 
Clopidogrel
View adult BNF View SPC online View childrens BNF
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  MHRA Drug Safety Update (December 2013): Clopidogrel - risk of acquired haemophilia with clopidogrel
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
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
Alternatives
Green plus
  • Only approved for use in accordance with NICE guidance.
 
Link  MHRA Drug Safety Update (January 2014): Prasugrel (Efient): increased risk of bleeding – advice around timing of loading dose for prasugrel
Link  NICE TA317 (replaces TA182): Acute coronary syndrome - prasugrel
 
Ticagrelor
View adult BNF View SPC online View childrens BNF
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
Alternatives
Red
 
 
Abciximab
View adult BNF View SPC online View childrens BNF
Alternatives
Red
 
 
Aspirin 500mg in 5ml injection
View adult BNF View SPC online View childrens BNF
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
Unlicensed Drug Unlicensed
Red
  • Approved for use in paediatric patients with Berlin Heart devices.
 
 
02.10  Expand sub section  Stable angina, acute coronary syndromes, and fibrinolysis to top
02.10.01  Expand sub section  Management of stable angina and acute coronary syndromes
02.10.02  Expand sub section  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
First Choice
Red
 
Alteplase
View adult BNF View SPC online View childrens BNF
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 NG128: Stroke and transient ischaemic attack in over 16s: diagnosis and initial management
Link  NICE TA264: Ischaemic stroke (acute) - alteplase
 
Tenecteplase (Metalyse®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Vials: 50mg
 
 
Urokinase
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
02.11  Expand sub section  Antifibrinolytic drugs and haemostatics
Tranexamic Acid
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Also available as a 500mg in 5ml syrup unlicensedunlicensed.
 
 
Tranexamic Acid Injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 100mg/ml Solution for Injection
 
 
Aminocaproic acid
View adult BNF View SPC online View childrens BNF
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
Unlicensed Drug Unlicensed
Red
  • For limited use in cardiothoracic surgery.
 
 
02.11  Expand sub section  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.

Antithrombin III (Kybernin®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
 
Beriplex - P/N®
(Dried Prothrombin Complex)
View adult BNF View SPC online View childrens BNF
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 IX
(Fraction, Dried)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
 
Factor VIIa
(Recombinant)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
 
Factor VIII
(Fraction, Dried)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
 
Factor VIII
(Inhibitor Bypassing Fraction)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
 
Factor XIII
(Fraction, Dried)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
 
Fibrinogen
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Octanate
View adult BNF View SPC online View childrens BNF
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
Formulary
Red
  • Solution for infusion containing 45-75mg/ml human plasma proteins.
 
 
Protein C Concentrate (Ceprotin®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
 
Prothrombin Complex Concentrate  (Octaplex®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
 
02.12  Expand sub section  Lipid-regulating drugs to top
Alirocumab
View adult BNF View SPC online View childrens BNF
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
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
 
Icosapent ethyl (Vazkepa®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Green plus
  • 998mg capsules
  • Icosapent ethyl is recommended as an option for reducing the risk of cardiovascular events in adults. It is recommended if they have a high risk of cardiovascular events and raised fasting triglycerides (1.7 mmol/litre or above) and are taking statins, but only if they have:
    • established cardiovascular disease (secondary prevention), defined as a history of any of the following:
      • acute coronary syndrome (such as myocardial infarction or unstable angina needing hospitalisation)
      • coronary or other arterial revascularisation procedures
      • coronary heart disease
      • ischaemic stroke
      • peripheral arterial disease, and
    • low-density lipoprotein cholesterol (LDL‑C) levels above 1.04 mmol/litre and below or equal to 2.60 mmol/litre
 
Link  NICE TA805: Icosapent ethyl with statin therapy for reducing the risk of cardiovascular events in people with raised triglycerides
 
Inclisiran (Leqvio®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Green

  • 284mg/1.5ml solution for injection pre-filled syringes

    • Approved for the treatment of primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia as an adjunct to diet in adults in line with NICE. 




 
Link  NICE TA 733 - Inclisiran for treating primary hypercholesterolaemia or mixed dyslipidaemia
 
02.12  Expand sub section  Bile acid sequestrants
Colestyramine
View adult BNF View SPC online View childrens BNF
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
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  Expand sub section  Ezetimibe
Bempedoic acid (Nilemdo®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Green
  • 180mg tablets
  • Approved for the treatment of primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia in adults in line with NICE and following the statin intensification pathway outlined in NEELI

 

 
Link  NICE TA694 - Bempedoic acid with ezetimibe for treating primary hypercholesterolaemia or mixed dyslipidaemia
 
Bempedoic acid with ezetimibe  (Nustendi®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Green
  • Bempedoic acid 180mg & ezetimibe 10mg tablets
  • Approved for the treatment of primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia in adults in line with NICE and following the statin intensification pathway outlined in NEELI

 

 
Link  NICE TA694 - Bempedoic acid with ezetimibe for treating primary hypercholesterolaemia or mixed dyslipidaemia
 
Ezetimibe
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Only approved for use in accordance with NICE guidance.
  • For further information refer to NEELI

 

 
Link  NICE TA385: Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia
 
02.12  Expand sub section  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
First Choice
Green

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

 
Bezafibrate
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
Link  MHRA Drug Safety Update (Dec 2010): Fibrates: first-line treatment not recommended
 
02.12  Expand sub section  Statins
Atorvastatin
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • 10mg, 20mg, 40mg & 80mg tablets
 
Rosuvastatin
View adult BNF View SPC online View childrens BNF
Formulary
Green
  •  5mg, 10mg, 20mg & 40mg tablets
    • May be used as an alternative to atorvastatin for primary or secondary prevention in line with NEELI guidance 

 

 
 
Simvastatin
View adult BNF View SPC online View childrens BNF
Alternatives
Green

  • 10mg, 20mg. 40mg & 80mg tablets

 
Link  MHRA Drug Safety Update (Dec 2014): Simvastatin: dose limitations with concomitant amlodipine or diltiazem
 
Atorvastatin Chewable
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • 10mg and 20mg chewable tablets
  • Note: atorvastatin 10mg and 20mg chewable tablets should be used instead of simvastatin suspension where solid dosage forms cannot be used. 

 

 
 
Pravastatin
View adult BNF View SPC online View childrens BNF
Alternatives
Green

  • 10mg, 20mg & 40mg tablets

 
 
02.12  Expand sub section  Nicotinic acid group to top
02.12  Expand sub section  Omega-3 fatty acid compounds
02.12  Expand sub section  PCSK9 inhibitors
02.12  Expand sub section  Other lipid modifying agents
02.13  Expand sub section  Local sclerosants
Ethanolamine Oleate
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Sodium Tetradecyl Sulphate
Formulary
Red
 
 
02.14  Expand sub section  Drugs affecting the ductus arteriosus to top
Indometacin 1mg injection
View adult BNF View SPC online View childrens BNF
First Choice
Red

unlicensedunlicensed

 
Ibuprofen 10mg injection (Pedea®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved only for use when there is a supply problem with indometacin.
 
 
02.15  Expand sub section  SGLT-2 inhibitor
Dapafliflozin (Forxiga®)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 5mg and 10mg tablets
  • Approved for treating chronic heart failure with reduced ejection fraction in line with NICE
  • Approved for treating chronic heart failure with preserved or mildly reduced ejection fraction in adults in line with NICE
 
Link  NICE TA679: Dapagliflozin for treating chronic heart failure with reduced ejection fraction
Link  NICE TA902: Dapagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction
 
Empagliflozin (Jardiance®)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 10mg and 25mg tablets
  • Approved for the treatment of chronic heart failure with reduced ejection fraction in adults in line with NICE
  • Approved for the treatment of chronic heart failure with preserved or mildly reduced ejection fraction in line with NICE
 
Link  NICE TA773: Empagliflozin for treating chronic heart failure with reduced ejection fraction
Link  NICE TA929: Empagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction
 
02.16  Expand sub section  Miscellaneous
Mavacamten (Camzyos®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved as an option for treating symptomatic obstructive hypertrophic cardiomyopathy in adults who have a New York Heart Association class of 2 to 3 in line with NICE and NHSE Specialised Commissioning guidance.
  • It is recommended only if:
    • it is an add‑on to individually optimised standard care that includes beta‑blockers, non-dihydropyridine calcium-channel blockers or disopyramide, unless these are contraindicated.


The following providers are commissioned to provide this service:

  • North Cumbria Integrated Care NHS Foundation Trust
  • South Tees Hospitals NHS Foundation Trust
  • The Newcastle upon Tyne Hospitals NHS Foundation Trust

 

 
Link  NICE TA913: Mavacamten for treating symptomatic obstructive hypertrophic cardiomyopathy
 
 ....
 Non Formulary Items
Aliskiren

View adult BNF View SPC online View childrens BNF
Non Formulary
Not Recomended

 

    • Note: not to be prescribed in new patients (July 2019).

 

    • Existing patients should be reviewed to evaluate ongoing care plans 

 

Link  Items not to be routinely prescribed in primary care
  
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
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. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

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 a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

netFormulary