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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.09  Expand sub section  Antiplatelet drugs
Aspirin
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Formulary
Green
  • 75mg dispersible tablets
  • Note: 75mg e/c tablets – no longer recommended for use.
 
 
Cangrelor (Kengrexal®)
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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
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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
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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
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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
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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
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Alternatives
Red
 
 
Abciximab
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Alternatives
Red
 
 
Aspirin 500mg in 5ml injection
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Unlicensed Drug Unlicensed
Red
  • For specialist use in the endovascular treatment of cerebral
    aneurysms
 
 
Clopidogrel 75mg in 5ml suspension
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Unlicensed Drug Unlicensed
Red
  • Approved for use in paediatric patients with Berlin Heart devices.
 
 
 ....
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
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Link to adult BNF
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Link to children's BNF
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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.  

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