netFormulary Northern Lincolnshire NHS
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.01  Positive inotropic drugs
02.01.01  Cardiac glycosides
Digoxin
(Tablets, elixir)
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Formulary
Green

Bioavailabilites are approximately: Injection 100%, Liquid 80%, Tablets 70%.

 

Red Traffic Light Digoxin 500micrograms/ml injection

Red Traffic Light Digoxin 100micrograms/ml injection. Hospital, Paediatrics Only (SP)

 
Link  SPS-Suggestions for Therapeutic Drug Monitoring in Adults in Primary Care
   
02.01.01  Digoxin-specific antibody
02.01.02  Phosphodiesterase type-3 inhibitors
Enoximone (Perfan®)
(Injection)
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Red
 
   
Milrinone
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Formulary
Red

Injection

 
   
02.02  Diuretics to top
02.02.01  Thiazides and related diuretics
Bendroflumethiazide
(Tablets )
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Formulary
Green
 
   
Chlorothiazide
(Chlorothiazide 250mg/5ml Suspension. Hospital, Paediatrics Only (U))
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Formulary
Red

Restricted Item  Suspension 250mg/5ml for paediatric use only. Available as an unlicensed product

 
   
Indapamide
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Formulary
Green

2.5mg Tablets

 
   
Metolazone
(unlicenced)
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Formulary
Red

Tablet was discontinued March 2012.

For patients in whom bendroflumethiazide is not suitable, an unlicensed import may be available for use by secondary care

 

 
   
02.02.02  Loop diuretics
Furosemide
(Tablets, Liquid )
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Formulary
Green

Red Traffic Light Injection.  IV doses of 40mg or 80mg can be slow bolused. Larger doses must be infused at a max rate of 4mg/min

 

 
   
Bumetanide
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Formulary
Green

Tablet, Liquid

Red Traffic Light Injection

 
   
02.02.03  Potassium-sparing diuretics and aldosterone antagonists
Amiloride Hydrochloride
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Formulary
Green
 
   
02.02.03  Aldosterone antagonists
Spironolactone
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First Choice
Green

FIRST CHOICE

 
Eplerenone
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Second Choice
Green

Tablet

Restricted Item 

SECOND CHOICE

Second line aldosterone antagonist if spironolactone is not tolerated for NYHA class II heart failure

Second Line agent if Spironolactone is not tolerated for use within the licenced indication, of stable post MI patient with left ventricular dysfunction and clinical evidence of heart failure in line with NICE guidance.

 

 
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

Tablet

 
   
02.02.05  Osmotic diuretics
Mannitol
(infusion)
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Formulary
Red

Hospital Only

 
   
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 (Adenocor®)
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Formulary
Red

injection

 
   
Dronedarone (Multaq®)
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Formulary
Red

Tablets

 
Link  NICE TA197: Atrial fibrillation - dronedarone
   
02.03.02  Supraventricular and ventricular arrhythmias
Amiodarone
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Formulary
Amber

Tablets

Red Traffic Light Injection is hospital only

 
   
Flecainide
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Formulary
Amber

Tablet and Syrup

 

 

 
   
Propafenone
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Formulary
Amber

Restricted Item Tablets

 
   
Disopyramide
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Formulary
Amber

capsules

MR tablets

 
   
Procainamide
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Formulary
Red

Injection

 
   
02.03.02  Ventricular arrhythmias to top
Lidocaine
(Cardiac)
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Formulary
Red

injection

 
   
02.04  Beta-adrenoceptor blocking drugs
Bisoprolol
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First Choice
Green

Tablets

First line use for all patients with systolic LV dysfunction

 

 
Atenolol
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Formulary
Green

Tablets, Syrup

Red Traffic Light Injection

 
   
Carvedilol
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Formulary
Green

Tablets

 
   
Celiprolol Hydrochloride
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Formulary
Red
 
   
Esmolol
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Formulary
Red

Injection/Infusion

 
   
Labetalol
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Formulary
Green

Tablets

Red Traffic Light Injection

 
   
Metoprolol
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Formulary
Green

Tablets

 
   
Nebivolol
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Formulary
Amber

Restricted Item

 
   
Propranolol
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Formulary
Green

Tablet

Restricted Item Capsule MR & Liquid

Red Traffic Light Injection

 
   
Sotalol
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Formulary
Green

Tablet

 
   
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

Tablets

Red Traffic Light Injection

 
   
Iloprost injection
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Formulary
Red
High Cost Medicine
 
   
Minoxidil
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Formulary
Red

Tablets

 
   
Sodium nitroprusside
 Track Changes
Formulary
Red

Injection

 
   
Tolazoline
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Formulary
Red

Injection.

Restricted Item Hospital, Paediatrics Only

 
   
02.05.02  Centrally acting antihypertensive drugs
Clonidine (Catapres®)
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Formulary
Green

Tablets

Red Traffic Light Injection

 
   
Methyldopa
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Formulary
Green

tablets

 
   
Moxonidine
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Formulary
Red

Tablets

 
   
02.05.03  Adrenergic neurone blocking drugs to top
Guanethidine Monosulphate (Ismelin®)
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Formulary
Red

injection

 
   
02.05.04  Alpha-adrenoceptor blocking drugs
Doxazosin
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Formulary
Green

Tablets

 
   
Indoramin
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Formulary
Green

Tablets

 
   
Prazosin
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Formulary
Green

Tablets

 
   
02.05.04  Phaeochromocytoma
Phenoxybenzamine Hydrochloride
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Formulary
Red

Capsules

Injection

 
   
Phentolamine (Rogitine®, Regitin®)
(antihypertensive)
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Formulary
Red

injection

 
   
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
Ramipril
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First Choice
Green

capsule and tablets

 
Captopril
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Formulary
Green

Tablets

Restricted Item Oral Solution

 
   
Enalapril
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Formulary
Green

Tablets

 
   
Lisinopril
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Formulary
Green

Tablets

 
   
Perindopril erbumine or tert-butylamine
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Formulary
Green

tablets

 
   
02.05.05.02  Angiotensin-II receptor antagonists
Candesartan
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Formulary
Green

Tablets

 
   
Irbesartan
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Formulary
Green

Tablets

 
   
Losartan
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Formulary
Green

Tablet

 
   
Valsartan
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Formulary
Green

Capsules, Tablets

 
   
02.05.05.03  Renin inhibitors
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

Available as S/L Tablet, Spray

Red Traffic Light Injection

Red Traffic Light  Restricted Item Patches

 
   
Isosorbide Dinitrate (Injection- Isoket® )
(Injection)
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Formulary
Red
 
   
Isosorbide Mononitrate
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Formulary
Green

Tablets

including Long acting, once daily preparation

 
   
02.06.02  Calcium-channel blockers
Amlodipine
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First Choice
Green

Tablets

 
Diltiazem
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Formulary
Green

Diltiazem MR (12hour) Tablets, Capsules. Prescribe by brand

Diltiazem XL (24 hour) Capsules. Prescribe by brand

 
   
Lercanidipine
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Formulary
Green
 
   
Nifedipine
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Formulary
Green

Capsules

Modified Release Tablets to be prescribed by Brand.

 
   
Nimodipine (Nimotop®)
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Formulary
Red

Tablets and Injection

 
   
Verapamil
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Formulary
Green

Tablets and Modified Release Tablets

Red Traffic Lightverapamil Injection

 
   
02.06.03  Other anitanginal drugs
Nicorandil
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Formulary
Green

Tablets

  • Not to be used as first-line treatment for angina in line with NICE and MHRA guidance.
  • See recent warnings regarding risk of serious skin, mucosal, and eye ulceration, which persists unless treatment is discontinued.

 

 
   
Ivabradine
(Angina)
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Formulary
Amber

Tablets

Specialist Initation only for two indications :

1) Angina

Cardiology specialist initiation only in line with NICE Clinical Guidance on stable angina for patients who remain symptomatic despite maximal doses of other anti-anginal medication. 

 

2) Heart Failure

In line with NICE TA 267.  Ivabradine is an option for treating people with chronic heart failure who meet the following criteria :

- with NYHA class II to IV stable chronic heart failure with systolic dysfunction and
- who are in sinus rhythm with a heart rate of 75 bpm or more and
- who are given ivabradine in combination with standard therapy including beta-blocker therapy, ACE inhibitors and aldosterone antagonists, or when beta-blocker therapy is contraindicated or not tolerated and
- with a left ventricular ejection fraction of 35% or less.

 
Link  MHRA Ivabradine (Procoralan) in the symptomatic treatment of angina: risk of cardiac side effects
Link  MHRA: Ivabradine: carefully monitor for bradycardia
Link  NICE CG126: Guidance on Stable Angina (2011)
Link  NICE guidance on stable angina
   
Ranolazine (Ranexa®)
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Restricted Drug Restricted
Amber

Modified Release Tablets

 

 
Link  NICE CG126: Guidance on Stable Angina (2011)
Link  Ranolazine prescribing Guideline
   
02.06.04  Peripheral vasodilators and related drugs
Naftidrofuryl
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Formulary
Green

Capsules

 
Link  NICE CG147: Lower limb peripheral arterial disease management
Link  NICE TA223: Intermittent claudication drugs
   
Pentoxifylline (Trental®)
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Formulary
Amber

Initiated by consultant immunologist for Behcets

 
   
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

injection

 
   
Dopamine
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Formulary
Red

injection

 
   
Dopexamine
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Formulary
Red

10mg/ml injection

 
   
02.07.02  Vasoconstrictor sympathomimetics
Midodrine
 Track Changes
Second Choice
Amber

Consultant initiation only when fludrocortisone ineffective for orthostatic hypotension.

 
Link  NICE Evidence Summary: Orthostatic hypotension due to autonomic dysfunction: midodrine
   
Ephedrine
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Formulary
Red

injection

 
   
Metaraminol
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Formulary
Red

Injection

 
   
Noradrenaline / Norepinephrine
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Formulary
Red

injection

 
   
Phenylephrine
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Formulary
Red
 
   
02.07.03  Cardiopulmonary resuscitation
Adrenaline / Epinephrine 1 in 10,000 (dilute)
(CPR)
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Formulary
Green
 
   
02.08  Anticoagulants and protamine
Idarucizumab (Praxbind®)
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Formulary
Red

Injection. For reversal of dabigatran anticoagulation only. Not suitable for Anti Xa Agents

 
   
02.08.01  Parenteral anticoagulants to top
02.08.01  Heparin
Heparin
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Formulary
Red

Injection

 
   
02.08.01  Low molecular weight heparins
Tinzaparin
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First Choice
Red
 
02.08.01  Heparinoids
02.08.01  Hirudins
Bivalirudin (Angiox®)
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Formulary
Red
 
Link  NICE TA230 : Bivalirudin for the treatment of STEMI, 2011
   
Lepirudin
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Formulary
Red
 
   
02.08.01  Heparin flushes to top
Heparin
(Flush)
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Formulary
Red

Flush Injection

 
   
02.08.01  Epoprostenol
02.08.01  Fondaparinux
Fondaparinux (Arixtra®)
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Formulary
Red

For Acute Coronary Syndrome

 
   
02.08.02  Oral anticoagulants
Edoxaban (Lixiana®)
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Formulary
Green

Tablets

Edoxaban is the preferred DOAC for stroke prevention in NVAF, please consult the DOAC guideline below

 
Link  DOAC Guideline
Link  NICE TA355:Edoxaban for preventing stroke/systemic embolism in non‑valvular atrial fibrillation
   
Acenocoumarol (Sinthrome®)
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Formulary
Green
 
   
Apixaban (Eliquis®)
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Formulary
Green

Tablets

 
Link  NICE TA275: Apixaban for AF
   
Dabigatran (Pradaxa®)
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Formulary
Green

Capsules

 
Link  NICE TA249: Dabigatran for Stroke prevention in AF
   
Phenindione
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Formulary
Green
 
   
Rivaroxaban (Xarelto®)
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Formulary
Green

Tablets

 
Link  NICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease
   
Warfarin
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Formulary
Green

Tablets

 
   
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
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Formulary
Red

Injection

 
   
02.09  Antiplatelet drugs
Aspirin
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Formulary
Green

Soluble Tablets

 
   
Clopidogrel
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Formulary
Green

Tablet

 
Link  MHRA Clopidogrel: risk of acquired haemophilia
Link  NICE TA20 Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
   
Dipyridamole MR
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Formulary
Green

Capsule

Amber Traffic Light Dipyridamole Suspension

Red Traffic Light Dipyridamole injection

 
Link  NICE TA20 Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
   
Prasugrel (Efient®)
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Formulary
Amber
 
Link  MHRA Prasugrel (Efient): increased risk of bleeding
Link  NICE TA 182 Prasugrel for the treatment of acute coronary syndromes with percutaneous coronary intervention
Link  NICE TA317 (replaces TA182): Acute coronary syndrome - prasugrel
   
Dipyridamole and Aspirin
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Formulary
Amber

Modified Release Capsule

 
Link  Asasantin Retard Discontinues
   
Ticagrelor (Brilique®)
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Formulary
Amber
 
Link  NICE TA236: Ticagrelor for the treatment of acute coronary syndromes
Link  NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction
   
Eptifibatide (Integrilin®)
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Formulary
Red

INJECTION

 
   
Tirofiban (Aggrastat®)
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Formulary
Red

INJECTION

 
   
Abciximab
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Formulary
Red

Injection

 
   
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
Alteplase (Actilyse®)
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Formulary
Red

injection

 
Link  NICE TA264: Ischaemic stroke (acute) - alteplase
   
Streptokinase
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Formulary
Red

injection

 
   
Tenecteplase (Metalyse®)
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Formulary
Red
 
   
Urokinase
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Formulary
Red
 

Restricted Drug injection

 
   
02.11  Antifibrinolytic drugs and haemostatics
Octocog alfa sucrose plasma protein-free (Iblias®)
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Formulary
Red
 
   
Tranexamic Acid
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Formulary
Green

Tablets

 Red Traffic Light injection

 
   
02.11  Blood-related products
Factor VIIa (Recombinant) (Novo 7®)
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Restricted Drug Restricted
Red
High Cost Medicine
 
   
02.12  Lipid-regulating drugs
02.12  Bile acid sequestrants to top
Colestyramine
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Formulary
Green

Sachets

 
   
02.12  Ezetimibe
Ezetimibe (Ezetrol®)
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Formulary
Green

To be used in accordance with associated NICE technical appraisal

 
Link  NICE TA385: Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia
   
02.12  Fibrates
Bezafibrate
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Formulary
Green

Tablets and Modified Release Tablets

 
   
02.12  Statins
Atorvastatin
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First Choice
Green
 
Pravastatin
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Formulary
Green

tablets

 
   
Rosuvastatin
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Restricted Drug Restricted
Green

Restricted ItemTablets

 
   
Simvastatin
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Formulary
Green

Tablets

 
   
02.12  Nicotinic acid group
02.12  Omega-3 fatty acid compounds to top
02.13  Local sclerosants
02.14  PCSK9 inhibitors
Alirocumab (Praluent®)
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Restricted Drug Restricted
Red
High Cost Medicine

Subcutaneous Injection

 
Link  NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
Evolocumab (Repatha® )
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Restricted Drug Restricted
Red
High Cost Medicine

Subcutaneous Injection

 
Link  NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
02.15  Neprilysin inhibitors
Sacubitril valsartan (Entresto®)
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Formulary
Amber

Tablets

Neprilysin Inhibitors with Angiotensin-II Receptor Antagonists

 

 
Link  NICE TA388: Sacubitril valsartan for heart failure (updated 16/7/16 to include adoption resources)
Link  Sacubitril Valsartan Prescribing Guideline
   
 ....
 Non Formulary Items
Digoxin specific antibody fragments  (Digifab®)
(Cardiac glycoside (digoxin) toxicity)

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Non Formulary
Grey
High Cost Medicine

Very rarely needed and extremely expensive. If required must be discussed with the National Poisons Centre (03448920111) first, then local Medicines Information

 
Felodipine

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Non Formulary
Grey
 
Gemifibrozil  (Lopid®)

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Non Formulary
 
Torasemide

View adult BNF View SPC online View childrens BNF
Non Formulary
 
  
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

Green

Green -Medicines suitable for routine use within primary care and Secondary care Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies  

Amber

Amber- Medicines suitable to be prescribed in primary care after specialist /Consultant recommendation or initiation. A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust Medicines and Therapeutic Committee and approved by the Area Prescribing Committee.   

Red

Red-Hospital initiation and continuation only  

Amber Shared Care Protocol

AMBER SHARE CARE PROTOCOL- Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised  

Blue

To be supplied from the appropriate commissioned provider.   

Green 2

GREEN 2- to be prescribed by primary care only   

Grey

GREY- NON FORMULARY (As agreed by Area Prescribing Committee)  

netFormulary