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 Formulary Chapter 2: Cardiovascular system - Full Chapter
Notes:

Review date: March 2020

Non-formulary drugs: Any drug or formulation not listed in the formulary is deemed to be non-formulary.

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups

Chapter Links...
 Details...
02.01  Positive inotropic drugs
02.01.01  Cardiac glycosides
Digoxin
View adult BNF View SPC online View childrens BNF
Formulary
Green
Red Triangle Take care when prescribing and dispensing
Digoxin has a low therapeutic index so cautious dose determination is essential and individual patient factors must be considered during formulation changes. Patient levels should be monitored appropriately.
The bioavailability of orally administered digoxin is approximately 63% in tablet form and 75% as the oral solution. This equates to ONE 62.5 microgram tablet being approximately equivalent to 50 micrograms (1 ml) elixir. However, the manufacturer is aware of one study showing no clinically relevant difference in bioavailability of digoxin tablets and elixir and suggests that these dosage forms can usually be used interchangeably.[SPS (2018)]
Tablets 62.5 micrograms, 125 micrograms, 250 micrograms
Oral solution 50 micrograms/ml

Amber Recommended Congestive heart failure

Amber Initiated Paediatrics

 
   
02.01.01  Digoxin-specific antibody
Digoxin specific antibody fragments
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
   
02.01.02  Phosphodiesterase type-3 inhibitors
Enoximone injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
5mg/mL 
   
Milrinone injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
1 mg/mL, 10-mL amp  
   
02.02  Diuretics to top
02.02.01  Thiazides and related diuretics
Chlortalidone tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

50mg tablets scored
(12.5–25mg once daily, recommended by NICE)

Amber Initiated paediatrics

 Not used at Alder Hey

 
   
Indapamide standard release tablets
View adult BNF View SPC online
Formulary
Green
2.5mg

N.B. the modified release preparation is not recommended

Paediatrics: no BNFc entry - seek specialist advice  
   
Bendroflumethiazide tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

2.5mg, 5mg 
 

Amber Initiated paediatrics

 
Link  NICE NG 136 Hypertension
   
Bendroflumethiazide tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

2.5mg, 5mg
For oedema

 
   
Chlorothiazide suspension
View childrens BNF
Unlicensed Drug Unlicensed
Amber Initiated

250mg in 5ml suspension

Unlicensed special Paediatrics only

 
   
Metolazone tablets
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Red

2.5mg, 5mg

Unlicensed special

Purple Wirral

 
   
02.02.02  Loop diuretics
Bumetanide tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

1mg, 5mg
 

Amber Initiated paediatrics

 
   
Bumetanide oral liquid
View adult BNF View childrens BNF
Formulary
Green

1mg/5ml
 

Amber Initiated paediatrics

 
   
Furosemide tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

20mg, 40mg
 

Amber Initiated paediatrics

 
   
Furosemide oral solution sugar free
View adult BNF View SPC online View childrens BNF
Formulary
Green

20mg/5mL, 40mg/5mL, 50mg/5mL
(50mg/5ml is standard strength used at Alder Hey)

Amber Initiated paediatrics

 
   
Furosemide tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

500mg

 
   
Furosemide injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
10mg/mL

May be used in the community as part of a specific service 
   
02.02.03  Potassium-sparing diuretics and aldosterone antagonists
Amiloride tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

5mg

Amber Initiated paediatrics

 
   
Amiloride oral solution sugar free
View adult BNF View SPC online View childrens BNF
Formulary
Green

5mg/5ml

Amber Initiated paediatrics

 
   
02.02.03  Aldosterone antagonists
Spironolactone tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

25mg, 50mg, 100mg 

Amber Initiated paediatrics

 
   
Spironolactone oral suspension
View adult BNF View SPC online View childrens BNF
Formulary
Green

5mg/5ml, 10mg/5ml, 25mg/5ml,50mg/5ml, 100mg/5ml
(50mg/5ml is standard strength used at Alder Hey)

Amber Initiated paediatrics

 
   
Eplerenone tablets
View adult BNF View SPC online
Formulary
Green

25mg, 50mg

Paediatrics: no BNFc entry - seek specialist advice

 
   
02.02.04  Potassium-sparing diuretics with other diuretics to top
 note 

Combination preparations are considered to be less suitable for prescribing than the separate components.

02.02.05  Osmotic diuretics
Mannitol intavenous infusion
View adult BNF View SPC online View childrens BNF
Formulary
Red
500mL infusion 10%, 20%  
   
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 injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
6mg/2mL 
   
Dronedarone tablets
View adult BNF View SPC online
Formulary
Red
400mg

Paediatrics: no BNFc entry - seek specialist advice 
Link  NICE TA197: Atrial fibrillation - dronedarone
   
02.03.02  Supraventricular and ventricular arrhythmias
Amiodarone hydrochloride tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

100mg, 200mg

 
   
Disopyramide capsules
View adult BNF View SPC online
Formulary
Amber Initiated

100mg

Paediatrics: no BNFc entry - seek specialist advice

 
   
Flecainide tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

50mg, 100mg

 
   
Propafenone hydrochloride tablets
View adult BNF View SPC online
Formulary
Amber Initiated

150mg, 300mg

Paediatrics: no BNFc entry - seek specialist advice

 
   
Amiodarone Suspension
View childrens BNF
Unlicensed Drug Unlicensed
Amber Initiated

Suspension 10mg/ml unlicensed special

Paediatrics: specialist centre usually tries to get patients onto doses which will allow use of 25mg segments of the 100mg tablets before discharge.

 
   
Flecainide liquid
View childrens BNF
Unlicensed Drug Unlicensed
Amber Initiated

Only available as an unlicensed special

5mg/ml is standard strength used at Alder Hey

 
   
02.03.02  Ventricular arrhythmias to top
Mexiletine
View adult BNF
Second Choice
Red
Capsules 150mg, 200mg, 250mg

Unlicensed "Special" 
   
Lidocaine hydrochloride injection
View adult BNF View SPC online View childrens BNF
Formulary
Red

1% (2mL, 5mL, 10mL, 20mL)

2% (2mL, 5mL, 10mL, 20mL)

 
   
02.04  Beta-adrenoceptor blocking drugs
Atenolol tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

25mg, 50mg, 100mg 

Amber Initiated paediatrics

 
   
Atenolol syrup sugar free
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tenormin® syrup 25mg/5ml

Amber Initiated paediatrics

 
   
Bisoprolol tablets
View adult BNF View SPC online
Formulary
Green

1.25mg, 2.5mg, 3.75mg, 5mg, 7.5mg, 10mg

May be prescribed in paediatrics under specialist advice. Dosage information from specialist centre. 

Amber Initiated paediatrics

 
   
Carvedilol tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

3.125mg, 6.25mg, 12.5mg, 25mg

Liquid 1mg/ml Extemp. preparation Alder Hey for paediatric use.

Amber Initiated paediatrics

 
   
Labetalol tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

100mg, 200mg 

Amber Initiated paediatrics

 
   
Metoprolol tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

50mg, 100mg 

Amber Initiated paediatrics

 
   
Nebivolol tablets
View adult BNF View SPC online
Formulary
Green

2.5mg, 5mg

Paediatrics: no BNFc entry - seek specialist advice

 
   
Propranolol tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

10mg, 40mg, 80mg, 160mg 

Amber Initiated paediatrics

 
   
Nadolol tablets
View adult BNF View SPC online
Formulary
Green

80mg licensed (40mg import- unlicensed in the UK)

Amber Initiated paediatrics

 
   
Propranolol m/r capsules
View adult BNF View SPC online View childrens BNF
Formulary
Green

80mg, 160mg 

Amber Initiated paediatrics

 
   
Propranolol oral solution
View adult BNF View SPC online View childrens BNF
Formulary
Green

5mg/5ml, 10mg/5ml, 40mg/5ml, 50mg/5ml
(50mg/5ml standard strength used at Alder Hey)

Amber Initiated paediatrics

 
   
Sotalol tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

40mg, 80mg, 160mg

 
   
Atenolol injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
500micrograms/mL 
   
Esmolol injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
10mg/ml 
   
Labetalol injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
5mg/mL 
   
Metoprolol injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
1mg/mL 
   
02.05  Drugs affecting the renin-angiotensin system and some other antihypertensive drugs
02.05.01  Vasodilator antihypertensive drugs
Hydralazine tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

25mg, 50mg

Amber Initiated paediatrics

 
   
Minoxidil tablets
View adult BNF View SPC online
Formulary
Amber Recommended

2.5mg, 5mg, 10mg

For renal use only.

Paediatrics: no BNFc entry - seek specialist advice

 
   
Ambrisentan tablets
View adult BNF View SPC online View childrens BNF
Formulary
Red
5mg, 10mg
NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

Pulmonary Arterial Hypertension 
   
Bosentan tablets
View adult BNF View SPC online View childrens BNF
Formulary
Red
62.5mg, 125mg
NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

Pulmonary hypertension, digital ulceration in systemic sclerosis only by NHSE designated specialist centres  
   
Epoprostenol injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
500microgram vial 
   
Iloprost nebules
View adult BNF View SPC online View childrens BNF
Formulary
Red
10mcg/ml 1ml vials.

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

 
   
Macitentan tablets
View adult BNF View SPC online
Formulary
Red
10mg
NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

Pulmonary Hypertension 
   
Riociguat tablets
View adult BNF View SPC online
Formulary
Red
NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
 
   
Sildenafil
View adult BNF View SPC online View childrens BNF
Formulary
Red
tablets 20mg

oral suspension - 10mg/mL

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents 
   
Tadalafil
View adult BNF View SPC online View childrens BNF
Formulary
Red
tablets 20mg

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents 
   
Iloprost injection
View childrens BNF
Unlicensed Drug Unlicensed
Red
Unlicensed special

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents 
   
Sodium Nitroprusside
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red

Injection 10mg/mL

 
   
02.05.02  Centrally acting antihypertensive drugs
Methyldopa tablets
View adult BNF View SPC online View childrens BNF
Second Choice
Green

125mg, 250mg, 500mg

Amber Initiated paediatrics

 
Link  NICE NG133 Hypertension in pregnancy: diagnosis and management
   
Clonidine tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

25micrograms,100micrograms scored

Amber Initiated paediatrics

 
   
Moxonidine tablets
View adult BNF View SPC online
Formulary
Amber Recommended

200micrograms, 300micrograms, 400micrograms

Paediatrics: no BNFc entry - seek specialist advice

 
   
02.05.03  Adrenergic neurone blocking drugs to top
02.05.04  Alpha-adrenoceptor blocking drugs
Doxazosin
View adult BNF View SPC online View childrens BNF
Formulary
Green

1mg, 2mg, 4mg 

Amber Initiated paediatrics

 
   
Doxazosin M/R
View adult BNF View SPC online View childrens BNF
Formulary
Black
4mg, 8mg 
Link   DOXAZOSIN modified release (M/R) tablets Pan Mersey Area Prescribing Committee Policy Statement
Link  UKMI Q&A: How should conversion between doxazosin formulations be carried out in patients with hypertension? (2016)
   
Prazosin tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

1mg, 2mg, 5mg

Restricted to nephrology patients.

 
   
Prazosin suspension
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Amber Initiated

500micrograms/5ml unlicensed special

 
   
02.05.04  Phaeochromocytoma
Phenoxybenzamine capsules
View adult BNF View SPC online View childrens BNF
Formulary
Amber Retained

10mg

For phaeochromcytoma only

 
   
Phentolamine injection
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red
10mg/mL

For phaeochromcytoma only

Paediatrics: no BNFc entry - seek specialist advice 
   
02.05.05  Drugs affecting the renin-angiotensin system
Sacubitril/Valsartan tablets (Entresto®)
View adult BNF View SPC online
Formulary
Amber Initiated
24mg/26mg, 49mg/51mg, 97mg/103mg

Prescribing and monitoring of sacubitril/valsartan must be retained by the heart failure team during dose titration and until the patient is stabilised on the maximum tolerated dose, this is expected to be a minimum of 3 months of prescribing by the heart failure team to allow dose titration and review of the patient once they are stable on optimum dose. 
Link  Pan Mersey APC (2019): Sacubitril/Valsartan film-coated tablets (Entresto®▼)
Link  NICE TA388: Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction
Link  North West Strategic Clinical Network: GP communication letter
Link  North West Strategic Clinical Network: Patient information leaflet
Link  North West Strategic Clinical Network: Position statement
Link  North West Strategic Clinical Network: Treatment algorithm
   
02.05.05  Heart Failure
02.05.05.01  Angiotensin-converting enzyme inhibitors (ACE inhibitors) to top
Captopril liquid
View adult BNF View childrens BNF
Formulary
Green

5mg/5ml, 25mg/5ml
First line in children until stabilised.
No longer routinely recommended in new adult patients. Patients currently stable may remain on treatment.

Amber Initiated paediatrics

 
   
Captopril tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

12.5mg, 25mg, 50mg
First line in children until stabilised.
No longer routinely recommended in new adult patients. Patients currently stable may remain on treatment.

Amber Initiated paediatrics

 
   
Enalapril tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

2.5mg, 5mg, 10mg, 20mg

No longer routinely recommended in new adult patients. Patients currently stable may remain on treatment.

Amber Initiated paediatrics

 
   
Lisinopril tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

2.5mg, 5mg, 10mg, 20mg 

Amber Initiated paediatrics

 
   
Perindopril erbumine tablets
View adult BNF View SPC online
Formulary
Green

2mg, 4mg, 8mg 
 

Amber Initiated paediatrics

Paediatrics: no BNFc entry - seek specialist advice

 
   
Ramipril capsules
View adult BNF View SPC online
Formulary
Green

1.25mg, 2.5mg, 5mg, 10mg 

Amber Initiated paediatrics

Paediatrics: no BNFc entry - seek specialist advice

 
   
Enalapril liquid
View childrens BNF
Unlicensed Drug Unlicensed
Green

Unlicensed special various strengths available from special–order manufacturers.
5mg/5ml is standard strength used at Alder Hey.
No longer routinely recommended in new adult patients. Patients currently stable may remain on treatment.

Amber Initiated paediatrics

 
   
Lisinopril liquid
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Green

Unlicensed special various strengths available from special–order manufacturers.
5mg/5ml is standard strength used at Alder Hey.

Amber Initiated paediatrics

 
   
02.05.05.02  Angiotensin-II receptor antagonists
Candesartan tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

2mg, 4mg, 8mg, 16mg, 32mg 

Amber Initiated paediatrics

 
   
Irbesartan tablets
View adult BNF View SPC online
Formulary
Green

75mg, 150mg, 300mg 
 
Amber Initiated paediatrics

Paediatrics: no BNFc entry - seek specialist advice

 
   
Losartan tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

12.5mg, 25mg, 50mg, 100mg 

Amber Initiated paediatrics

 
   
Losartan oral suspension
View adult BNF View SPC online View childrens BNF
Formulary
Green

12.5mg/5ml when reconstituted 

Amber Initiated paediatrics

 
   
Valsartan tablets and capsules
View adult BNF View SPC online View childrens BNF
Formulary
Green

40mg, 80mg, 160mg, 320mg

Amber Initiated paediatrics

 
   
ARB + ACEI combination
Formulary
Red
 
Link  Combination use of medicines from different classes of renin-angiotensin system blocking agents: MHRA Medicines and Healthcare Products Regulatory Agency
   
02.05.05.03  Renin inhibitors
Aliskiren tablets
View adult BNF View SPC online
Formulary
Black
150mg, 300mg 
   
02.06  Nitrates, calcium-channel blockers, and potassium-channel activators
02.06  Angina
02.06.01  Nitrates to top
Glyceryl Trinitrate sublingual tablets
View adult BNF View SPC online
Formulary
Green
300micrograms, 500micrograms, 600micrograms


Paediatrics: no BNFc entry - seek specialist advice 
   
Glyceryl Trinitrate patches
View adult BNF View SPC online
Formulary
Green

5mg/24 hours, 10mg/24 hours

Amber Initiated paediatrics

Paediatrics: no BNFc entry - seek specialist advice

 
Link  Glyceryl trinitrate patch: Pan Mersey Prescribing Support Information for Children
   
Glyceryl Trinitrate spray
View adult BNF View SPC online
Formulary
Green
400micrograms/metered dose


Paediatrics: no BNFc entry - seek specialist advice 
   
Isosorbide Mononitrate tablets
View adult BNF View SPC online
Formulary
Green
10mg, 20mg, 40mg
M/R 25mg, 40mg, 50mg, 60mg


Paediatrics: no BNFc entry - seek specialist advice 
   
Isosorbide Dinitrate injection
View adult BNF View SPC online
Formulary
Red
0.1% injection (1mg/mL) 10mL amps

Paediatrics: no BNFc entry - seek specialist advice 
   
02.06.02  Calcium-channel blockers
Amlodipine tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

5mg, 10mg

Amber Initiated paediatrics

 
   
Amlodipine liquid
View adult BNF View childrens BNF
Formulary
Green

1mg/ml and 2mg/ml

Amber Initiated paediatrics

 
   
Diltiazem tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

60mg 
 
Amber Initiated paediatrics only for Raynaud’s syndrome

 
   
Diltiazem modified release
View adult BNF View SPC online
Formulary
Green

Different versions of modified release containing more than 60mg may not have the same clinical effect so should be prescribed by brand.
Modified release available as 60mg, 90mg, 120mg, 180mg, 200mg, 240mg, 300mg and 360mg formulations suitable for either once or twice daily administration depending on brand.
 
Amber Initiated paediatrics : only for Raynaud’s syndrome

Paediatrics: no BNFc entry - seek specialist advice

 
   
Felodipine m/r tablets
View adult BNF View SPC online
Formulary
Green
2.5mg, 5mg, 10mg



Paediatrics: no BNFc entry - seek specialist advice 
   
Nifedipine m/r tablets and capsules
View adult BNF View SPC online View childrens BNF
Formulary
Green

All modified release preparations of nifedipine must be prescribed by brand.
Modified release available as 10mg, 20mg, 30mg, 40mg and 60mg formulations suitable for either once or twice daily administration depending on brand.

Amber Initiated paediatrics

 
   
Nifedipine capsules
View adult BNF View SPC online View childrens BNF
Formulary
Green

5mg, 10mg 

Amber Initiated paediatrics

 
   
Verapamil modified release
View adult BNF View SPC online View childrens BNF
Formulary
Green

120mg, 180mg, 240mg

Amber Initiated paediatrics

 
   
Verapamil tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

40mg, 80mg 

Amber Initiated paediatrics

 
   
Verapamil oral solution
View adult BNF View SPC online View childrens BNF
Formulary
Green

40mg/5ml
Not used at Alder Hey

Amber Initiated paediatrics

 
   
Nimodipine tablets
View adult BNF View SPC online View childrens BNF
Formulary
Red
30mg  
   
Nimodipine intravenous infusion
View adult BNF View SPC online View childrens BNF
Formulary
Red
200microgram/ml 50ml vial 
   
Nifedipine oral liquid
View childrens BNF
Unlicensed Drug Unlicensed
Green

Unlicensed special oral drops 20mg/ml

Amber Initiated paediatrics

 
   
02.06.03  Other anitanginal drugs
Ivabradine tablets
View adult BNF View SPC online
Formulary
Green
Angina 5mg, 7.5mg


Paediatrics: no BNFc entry - seek specialist advice 
Link  MHRA Ivabradine-risk of cardiac side effects new advice
   
Ivabradine tablets
View adult BNF View SPC online
Formulary
Amber Initiated
Heart failure 5mg, 7.5mg

Paediatrics: no BNFc entry - seek specialist advice 
Link  IVABRADINE (Procoralan®▼) for the treatment of chronic heart failure Pan Mersey APC Policy Statement
Link  NICE TA267: Chronic heart failure - ivabradine
   
Nicorandil tablets
View adult BNF View SPC online
Formulary
Green
10mg, 20mg

Paediatrics: no BNFc entry - seek specialist advice

Due to risk of ulcer complications use nicorandil for treatment of stable angina only in patients whose angina is inadequately controlled by other anti-anginal therapies, or who have a contraindication or intolerance to other anti-anginal therapies such as beta-blockers or calcium antagonists.  
Link  Drug Safety Update Jan 2016 Nicorandil (Ikorel): now second-line treatment for angina - risk of ulcer complications
   
Ranolazine m/r tablets
View adult BNF View SPC online
Formulary
Green

375mg, 500mg, 750mg

As adjunctive therapy in line with licence after calcium channel blockers and beta blockers

Dose titration necessary: The recommended initial dose is 375 mg twice daily. After 2–4 weeks, the dose should be titrated to 500 mg twice daily and, according to the patient's response, further titrated to a recommended maximum dose of 750 mg twice daily. If patient experiences treatment-related adverse events (e.g. dizziness, nausea, or vomiting), down-titration to 500 mg or 375 mg twice daily may be required.



Paediatrics: no BNFc entry - seek specialist advice

 
   
02.06.04  Peripheral vasodilators and related drugs
Naftidrofuryl oxalate capsules
View adult BNF View SPC online
Formulary
Green
100mg

Paediatrics: no BNFc entry - seek specialist advice 
   
Iloprost infusion
View childrens BNF
Formulary
Red

Concentrate for infusion 100micrograms/ml

Paediatrics: only for Raynaud’s syndrome.

 
   
Cilostazol tablets
View adult BNF View SPC online
Formulary
Black
50mg, 100mg 
   
Inositol nicotinate tablets
View adult BNF View SPC online
Formulary
Black
500mg, 750mg
 
   
Pentoxifylline tablets
View adult BNF View SPC online
Formulary
Black
400mg 
   
02.06.04  Other preparations used in peripheral vascular disease
02.07  Sympathomimetics to top
02.07.01  Inotropic sympathomimetics
Dobutamine hydrochloride infusion
View adult BNF View SPC online View childrens BNF
Formulary
Red
12.5mg/mL concentrate for IV infusion 20mL amps 
   
Dopamine hydrochloride infusion
View adult BNF View SPC online View childrens BNF
Formulary
Red
40mg/mL concentrate for IV infusion 5mL amps 
   
02.07.02  Vasoconstrictor sympathomimetics
Midodrine tablets
View adult BNF View SPC online
Formulary
Amber Initiated
2.5mg, 5mg
Oral alpha agonist treatment for severe orthostatic
hypotension due to autonomic dysfunction when corrective factors have been ruled out and other forms of treatment are inadequate.

Paediatrics: no BNFc entry - seek specialist advice  
   
Ephedrine hydrochloride injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
30mg/mL injection 1mL amps
3mg/mL injection 10mL amps 
   
Noradrenaline / Norepinephrine injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
Noradrenaline base 1mg/mL 4ml amps 
   
Phenylephrine hydrochloride injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
10mg/mL 1ml amps 
   
Metaraminol injection
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Red
10mg/mL injection
Unlicensed special 
   
02.07.03  Cardiopulmonary resuscitation
Adrenaline / Epinephrine Intravenous injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
1 in 10,000 (100microgram/mL) injection 
   
02.08  Anticoagulants and protamine
02.08.01  Parenteral anticoagulants to top
Argatroban
View adult BNF View SPC online
Formulary
Red

Injection 100mg/mL

 
   
02.08.01  Heparin
Heparin sodium injection (unfractionated)
View adult BNF View SPC online View childrens BNF
Formulary
Red
1,000 units/mL (1mL, 5mL, 20mL amps)
5,000 units/mL (1mL amp) restricted use
 
   
02.08.01  Low molecular weight heparins
 note 

Pan Mersey APC (2018). Prescribing Support Information: LMWH for Adults
(The product used is by individual hospital choice)

Dalteparin sodium injection
View adult BNF View SPC online View childrens BNF
Formulary
Amber Retained

12 500 units/mL,  2500-unit (0.2-mL) syringe 

25 000 units/mL, 5000-unit (0.2-mL) syringe , 7500-unit (0.3-mL) syringe, 10 000-unit (0.4-mL) syringe, 12 500-unit (0.5-mL) syringe, 15 000-unit (0.6-mL) syringe, 18 000-unit (0.72-mL) syringe2,500 units/mL, 4mL (10,000-unit) amps10,000 units/mL, 1mL (10,000-unit) amps25,000 units/mL, 4-mL (100,000-unit) amps10,000 units/mL, 1-mL (10,000-unit) graduated syringeRED when used as surgical or medical VTE prophylaxis or treatment in hospital, or for prevention of miscarriage in women with history of recurrent miscarriage for the duration of treatment during pregnancy.Red paediatrics

 
   
Enoxaparin sodium injection
View adult BNF View SPC online View childrens BNF
Formulary
Amber Retained

100 mg/mL: 20-mg (0.2-mL, 2,000-units) syringe 40-mg (0.4-mL, 4,000-units) syringe 60-mg (0.6-mL, 6,000-units) syringe 80-mg (0.8-mL, 8,000-units) syringe 100-mg (1-mL, 10,000-units) syringe 300 mg (3-mL, 30,000-units) vial 150 mg/mL: 120-mg (0.8-mL, 12,000-units) syringe 150-mg (1-mL, 15,000-units) syringe

Enoxaparin is now available as the originator brand (Clexane®) and biosimilar brand (Inhixa®). Prescribing should be by brand to ensure that the correct product is selected for prescribing, dispensing and administration due to differences in syringe design.RED when used as surgical or medical VTE prophylaxis or treatment in hospital, or for prevention of miscarriage in women with history of recurrent miscarriage for the duration of treatment during pregnancy.Red paediatrics

 
   
Tinzaparin sodium injection
View adult BNF View SPC online View childrens BNF
Formulary
Amber Retained

10,000 units/mL: 2,500-unit (0.25-mL) syringe 3,500-unit (0.35-mL) syringe 4,500-unit (0.45-mL) syringe 20,000-unit (2-mL) vial 20,000 units/mL: 0.5mL (10,000-unit) syringe 0.7-mL (14,000-unit) syringe 0.9-mL (18,000-unit) syringe 2-mL (40,000-unit) vial

 RED when used as surgical or medical VTE prophylaxis or treatment in hospital, or for prevention of miscarriage in women with history of recurrent miscarriage for the duration of treatment during pregnancy.Red paediatrics

 
   
02.08.01  Heparinoids
Danaparoid sodium injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
1,250 units/mL, 0.6-mL amp (750 units) 
   
02.08.01  Hirudins
Bivalirudin injection
View adult BNF View SPC online
Formulary
Red
powder for reconstitution 250mg vial

Paediatrics: no BNFc entry - seek specialist advice 
Link  NICE TA230 : Bivalirudin for the treatment of STEMI, 2011
   
02.08.01  Heparin flushes to top
Heparin
View adult BNF View SPC online View childrens BNF
Formulary
Red

Flush 10units/mL, 100units/mL

The use of heparin flushes should be kept to a minimum. For maintaining patency of peripheral venous catheters, sodium chloride injection 0.9% is as effective as heparin flushes. The role of heparin flushes in maintaining patency of arterial and central venous catheters is unclear.

 
   
02.08.01  Epoprostenol
Epoprostenol
View adult BNF View SPC online View childrens BNF
Formulary
Red
500micogram and 1.5mg vials for reconstitution

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
 
   
02.08.01  Fondaparinux
Fondaparinux sodium injection
View adult BNF View SPC online
Formulary
Red

2.5mg/0.5mL prefilled syringe


Paediatrics: no BNFc entry - seek specialist advice

 
   
02.08.02  Oral anticoagulants
 note 

Oral anticoagulants

Paediatric use

In paediatrics only warfarin is used as an anticoagulant

 

Warfarin tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

500micrograms, 1mg, 3mg, 5mg

Amber Initiated Treatment and secondary prevention of DVT/PE. Includes initiation by specialist warfarin service.

Amber Initiated paediatrics

 
   
Warfarin oral suspension
View adult BNF View SPC online View childrens BNF
Formulary
Green

5mg/5ml
 
Amber Initiated paediatrics

Specialist Centre usually tries to get patients onto 1mg tablets before discharge.

 
   
Acenocoumarol tablets
View adult BNF View SPC online
Formulary
Green
1mg


Paediatrics: only warfarin is used in paediatrics 
   
Phenindione tablets
View adult BNF View SPC online
Formulary
Green
10mg, 25mg, 50mg

Paediatrics: only warfarin is used in paediatrics 
   
Apixaban tablets
View adult BNF View SPC online
Formulary
Green

2.5mg, 5mg
Prevention of stroke and systemic embolism in atrial fibrillation.

Paediatrics: only warfarin is used in paediatrics

The Pan Mersey APC recommends in the absence of a specific clinical reason to select a particular DOAC, that the least costly DOAC is the first line DOAC for patients with non-valvular AF. Currently this is edoxaban.

 
Link  APIXABAN tablets (Eliquis®▼) in Atrial Fibrillation Pan Mersey Area Prescribing Committee Policy Statement
Link  NICE TA275: Stroke and systemic embolism (prevention, non-valvular atrial fibrillation) - apixaban
   
Apixaban tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

2.5mg, 5mg
Treatment and secondary prevention of DVT/PE

N.B. Green in Wirral for this indication.

Paediatrics: only warfarin is used in paediatrics

 
Link  NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
Link  Non-Vitamin K Antagonist oral anticoagulants (NOACs) for the treatment and prevention of Deep Vein Thrombosis (DVT) and/or Pulmonary Embolism (PE), Pan Mersey Area Prescribing Committee Policy Statement
   
Apixaban tablets
View adult BNF View SPC online
Formulary
Red

2.5mg, 5mg
VTE prophylaxis in patients who have undergone elective hip and knee replacement surgery.

Paediatrics: only warfarin is used in paediatrics

 
Link  NICE TA245: Venous thromboembolism - Apixaban (hip and knee surgery)
   
Dabigatran capsules
View adult BNF View SPC online
Formulary
Red
75mg, 110mg, 150mg
VTE prophylaxis in patients who have undergone elective hip and knee replacement surgery

Paediatrics: only warfarin is used in paediatrics 
Link  NICE TA157: Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults
   
Dabigatran capsules
View adult BNF View SPC online
Formulary
Amber Initiated

75mg, 110mg, 150mg
Secondary prevention of Deep Vein Thrombosis and/or Pulmonary Embolism

N.B. Green in Wirral for this indication.

Paediatrics: only warfarin is used in paediatrics

 
Link  NICE TA327: Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
Link  Non-Vitamin K Antagonist oral anticoagulants (NOACs) for the treatment and prevention of Deep Vein Thrombosis (DVT) and/or Pulmonary Embolism (PE), Pan Mersey Area Prescribing Committee Policy Statement
   
Dabigatran capsules
View adult BNF View SPC online
Formulary
Green

75mg, 110mg, 150mg
Prevention of stroke and systemic embolism in atrial fibrillation.

Paediatrics: only warfarin is used in paediatrics

The Pan Mersey APC recommends in the absence of a specific clinical reason to select a particular DOAC, that the least costly DOAC is the first line DOAC for patients with non-valvular AF. Currently this is edoxaban.

 
Link  DABIGATRAN (Pradaxa®▼) in Atrial Fibrillation Pan Mersey Area Prescribing Committee Policy Statement
Link  NICE TA249: Dabigatran for Stroke prevention in AF
   
Edoxaban tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

15mg, 30mg, 60mg
Treatment and prevention of PE and DVT

N.B. Green in Wirral for this indication.

Paediatrics: only warfarin is used in paediatrics

 
Link  NICE TA354: Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism
Link  Non-Vitamin K Antagonist oral anticoagulants (NOACs) for the treatment and prevention of Deep Vein Thrombosis (DVT) and/or Pulmonary Embolism (PE), Pan Mersey Area Prescribing Committee Policy Statement
   
Edoxaban tablets
View adult BNF View SPC online
Formulary
Green

15mg, 30mg, 60mg
Prevention of stroke and systemic embolism in atrial fibrillation

Paediatrics: only warfarin used in paediatrics

The Pan Mersey APC recommends in the absence of a specific clinical reason to select a particular DOAC, that the least costly DOAC is the first line DOAC for patients with non-valvular AF. Currently this is edoxaban.

 
Link  EDOXABAN tablets (Lixiana®▼)for stroke prevention in atrial fibrillation, Pan Mersey Area Prescribing Committee Policy Statement
Link  NICE TA355: Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation
Link  Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken with food
   
Rivaroxaban
View adult BNF View SPC online
Formulary
Grey

tablets 2.5mg

For the prevention of atherothrombotic events in adult patients with coronary artery disease or symptomatic peripheral artery disease at high risk of ischaemic events - in combination with aspirin.

Paediatrics: no BNFc entry - seek specialist advice

 
Link  Pan Mersey APC: RIVAROXABAN 2.5mg tablets (Xarelto®▼) for the prevention of atherothrombotic events.
   
Rivaroxaban tablets
View adult BNF View SPC online
Formulary
Green

10mg, 15mg, 20mg
Prevention of stroke and systemic embolism in atrial fibrillation

Paediatrics: only warfarin is used in paediatrics

The Pan Mersey APC recommends in the absence of a specific clinical reason to select a particular DOAC, that the least costly DOAC is the first line DOAC for patients with non-valvular AF. Currently this is edoxaban.

 
Link  MHRA (2019). Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken with food
Link  NICE (2012). Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
Link  Pan mersey (2018). Direct Oral Anticoagulants (DOACs) (previously known as NOACs) in Non-Valvular Atrial Fibrillation
   
Rivaroxaban tablets
View adult BNF View SPC online
Formulary
Amber Initiated

10mg, 15mg, 20mg
Treatment and prevention of PE and DVT

N.B. Green in Wirral for this indication.

2.5mg tablets - Acute Coronary Syndrome (ACS) only

Paediatrics: only warfarin is used in paediatrics

 
Link  MHRA (2019) Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken with food
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
Link  Pan Mersey APC (2017) RIVAROXABAN tablets (Xarelto®▼) in Acute Coronary Syndrome
Link  Pan Mersey APC (2018) Non-Vitamin K Antagonist oral anticoagulants (NOACs) for the treatment and prevention of Deep Vein Thrombosis (DVT) and/or Pulmonary Embolism (PE)
Link  Pan Mersey APC (2018) RIVAROXABAN 2.5mg tablets (Xarelto®▼) for the prevention of atherothrombotic events
   
Rivaroxaban tablets
View adult BNF View SPC online
Formulary
Red
10mg, 15mg, 20mg
VTE prophylaxis in patients who are having elective hip and knee replacement surgery

Paediatrics: only warfarin is used in paediatrics 
Link  MHRA (2019) Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken with food
Link  NICE (2009) Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults
   
Idarucizumab
View adult BNF View SPC online
Formulary
Red
Praxbind® 2.5g/50mL solution for injection/infusion 
   
02.08.03  Protamine sulphate
Protamine Sulphate injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
10mg/mL, 5mL amps 
   
02.09  Antiplatelet drugs to top
Aspirin tablets (antiplatelet)
View adult BNF View SPC online View childrens BNF
Formulary
Green

75mg
 
Amber Initiated paediatrics

Unlicensed in children

 
Link  UKMI Q&A: Is there evidence to support the use of EC aspirin to reduce GI side effects in cardiovascular patients? (2017)
   
Clopidogrel tablets
View adult BNF View SPC online
Formulary
Green

75mg
 
 
Amber Initiated paediatrics

Paediatrics: no BNFc entry - seek specialist advice. Dosage information from initiating centre.

 
Link  NICE TA80: Acute coronary syndromes - clopidogrel
   
Dipyridamole MR capsules
View adult BNF View SPC online
Formulary
Green
200mg

Paediatrics: no BNFc entry - seek specialist advice 
   
Dipyridamole oral suspension
View adult BNF View SPC online View childrens BNF
Formulary
Green

50mg/5ml, 200mg/5ml

Amber Initiated paediatrics

 
   
Dipyridamole tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

25mg, 100mg

For paediatrics

 
   
Prasugrel tablets
View adult BNF View SPC online
Formulary
Amber Initiated

5mg, 10mg

Paediatrics: no BNFc entry - seek specialist advice

 
Link  NICE TA317: Acute coronary syndrome - prasugrel
   
Ticagrelor
View adult BNF View SPC online
Formulary
Amber Initiated

Tablets 90mg, 60mg

Orodispersible tablets 90mg

Maximum treatment duration of 1 year at 90mg bd; extended treatment with 60mg bd up to a maximum of 3 years.     

 

Paediatrics: no BNFc entry - seek specialist advice

 
Link  Pan Mersey APC (2019): Ticagrelor tablets (Brilique®)
Link  NICE TA236: Acute coronary syndromes - ticagrelor
Link  NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction
   
Abciximab
View adult BNF View SPC online
Formulary
Red
2mg/mL, 5mL vial

Paediatrics: no BNFc entry - seek specialist advice 
   
Eptifibatide
View adult BNF View SPC online
Formulary
Red
2mg/mL 10mL vial
750micrograms/mL 100mL vial

Paediatrics: no BNFc entry - seek specialist advice 
   
Tirofiban
View adult BNF View SPC online
Formulary
Red
Concentrate for intravenous infusion, 250micrograms/mL. For dilution before use, 50mL (12.5mg) vial
Intravenous infusion, 50 micrograms/mL, 250mL bag

Paediatrics: no BNFc entry - seek specialist advice 
   
Aspirin suppositories
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Green

Unlicensed special 

Amber Initiated paediatrics

 
   
02.10  Stable angina, acute coronary syndromes, and fibrinolysis
02.10.01  Management of stable angina and acute coronary syndromes
02.10.02  Fibrinolytic drugs
Alteplase
View adult BNF View SPC online View childrens BNF
Formulary
Red
10mg (5.8 million units)/vial
20mg (11.6 million units)/vial
50mg (29 million units)/vial
 
Link  NICE TA264: Ischaemic stroke (acute) - alteplase
   
Streptokinase
View adult BNF View SPC online View childrens BNF
Formulary
Red
1.5 million unit vial 
   
Tenecteplase
View adult BNF View SPC online
Formulary
Red
10,000 units (50mg) vial
8,000 units (40mg) vial

Paediatrics: no BNFc entry - seek specialist advice 
   
Urokinase
View adult BNF View SPC online View childrens BNF
Formulary
Red
10,000 unit vial
25,000 unit vial

 
   
02.11  Antifibrinolytic drugs and haemostatics
Tranexamic acid tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green
500mg

 
   
Tranexamic acid injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
100mg/mL 5mL amp 
   
Tranexamic acid liquid
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Green
500mg/ml unlicensed special


 
   
02.11  Blood-related products to top
 note  NHS NHSE commissioned service- see Specialised Commissioning: Key documents  for further information.
02.12  Lipid-regulating drugs
Alirocumab
View adult BNF View SPC online View childrens BNF
Formulary
Red

75mg/mL; 150mg/mL pre-filled syringe (Praluent®)

GREY for cardiovascular risk reduction in adults with atherosclerotic cardiovascular disease

 
Link  Pan Mersey APC (2019): ALIROCUMAB solution for injection (Praluent®▼) for reduction of cardiovascular risk in adults with established atherosclerotic cardiovascular disease
Link  ALIROCUMAB injection (Praluent®▼) Pan Mersey Area Prescribing Committee policy statement
Link  NICETA 393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
Evolocumab
View adult BNF View SPC online
Formulary
Red

140mg solution for injection in pre-filled pen (Repatha®)

NHS NHSE commissioned drug for treatment of homozymgous familial hypercholesterolaemia only. All other licensed indications are CCG commissioned.

Black for cardiovascular risk reduction in adults with atherosclerotic cardiovascular disease

 
Link  NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
Link  Pan Mersey APC (2019). EVOLOCUMAB injection (Repatha SureClick®▼) for reduction of cardiovascular risk in adults with established atherosclerotic cardiovascular disease
   
02.12  Statins
Atorvastatin tablets
View adult BNF View SPC online View childrens BNF
First Choice
Green

10mg, 20mg, 40mg, 80mg

Amber Initiated paediatrics

Black Atozet® atorvastatin 20mg + ezetimibe 10mg

 
Pravastatin tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

10mg, 20mg, 40mg

Amber Initiated paediatrics

 
   
Simvastatin tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

10mg, 20mg, 40mg

Amber Initiated paediatrics

Black Inegy® ezetimibe/simvastatin 10mg/20mg, 10mg/40mg, 10mg/80mg

 
Link  Inegy®: ORAL COMBINATION PRODUCTS; Pan Mersey Area Prescribing Committee Policy Statement
   
Simvastatin oral suspension
View adult BNF View SPC online View childrens BNF
Formulary
Green

20mg/5ml, 40mg/5ml

Amber Initiated paediatrics

 
   
Rosuvastatin tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

5mg, 10mg, 20mg, 40mg

N.B. restricted use ONLY where no other statin is suitable(see link below). 

Amber Initiated paediatrics

 
Link  ROSUVASTATIN tablets (Crestor®) Pan Mersey Area Prescribing Committee Policy Statement
   
02.12  Bile acid sequestrants
Colestyramine powder sachets
View adult BNF View SPC online View childrens BNF
Formulary
Green

4g/sachet

Amber Initiated paediatrics

 
   
Colesevelam tablets
View adult BNF View SPC online
Formulary
Amber Initiated

625mg

Lipid specialist only

Paediatrics: no BNFc entry - seek specialist advice

 
   
02.12  Ezetimibe
Ezetimibe
View adult BNF View SPC online View childrens BNF
Formulary
Green

10mg 
 
Amber Initiated paediatrics

Black Atozet® atorvastatin 20mg + ezetimibe 10mg

Grey for prevention of cardiovascular events in patients with CHD and history of ACS where patient choleterol levels are within target range

 
Link  Atozet: ORAL COMBINATION PRODUCTS, PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT
Link  EZETIMIBE (Ezetrol®) for the prevention of cardiovascular events; Pan Mersey Area Prescribing Committee Prescribing Policy Statement
Link  NICE TA385: Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia
   
02.12  Fibrates to top
Fenofibrate capsules
View adult BNF View SPC online View childrens BNF
Second Choice
Green

67mg, 200mg, 267mg

Second choice if statin contraindicated or not tolerated.

67mg can be used in renal impairment but check dose.
200mg and 267mg NOT to be used in renal impairment.

Amber Initiated paediatrics

 
   
Fenofibrate tablets
View adult BNF View SPC online
Second Choice
Green

160mg

Second choice if statin contraindicated or not tolerated.

Amber Initiated paediatrics

Paediatrics: no BNFc entry - seek specialist advice

 
   
02.12  Nicotinic acid group
02.12  Omega-3 fatty acid compounds
Omega-3-Acid Ethyl Esters capsules
View adult BNF View SPC online
Formulary
Amber Initiated

Hypertriglyceridaemia 

For prevention of pancreatitis, as an additional / alternative option after fibrates and statin therapy where these are insufficiently effective at maximally tolerated doses or where they are contraindicated, where serum triglycerides >10mml/L.
 
1g of omega-3-acid ethyl esters 90 containing eicosapentaenoic acid 460mg and docosahexaenoic acid 380mg
 

 
   
Omega-3-Acid Ethyl Esters capsules
View adult BNF View SPC online
Formulary
Black
Primary or secondary prevention of CVD

1g of omega-3-acid ethyl esters 90 containing eicosapentaenoic acid 460mg and docosahexaenoic acid 380mg

 
   
Omega-3-Acid Ethyl Esters capsules
View adult BNF View SPC online
Formulary
Black
Management of patients with primary IgA nephropathy

1g of omega-3-acid ethyl esters 90 containing eicosapentaenoic acid 460mg and docosahexaenoic acid 380mg

 
   
Omega-3-Acid Ethyl Esters capsules
View adult BNF View SPC online
Formulary
Black
Multiple sclerosis

1g of omega-3-acid ethyl esters 90 containing eicosapentaenoic acid 460mg and docosahexaenoic acid 380mg

 
Link  NICE guidelines CG186: Multiple sclerosis
   
02.13  Local sclerosants
Sodium Tetradecyl Sulphate injection (Fibrovein®)
View adult BNF View SPC online
Formulary
Red
1% (2mL)
3% (2mL, 5mL)

Paediatrics: no BNFc entry - seek specialist advice 
   
 ....
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

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Requires specialist assessment to enable patient selection.  Amber Recommended medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Following specialist assessment, the medicine is suitable for prescribing in Primary Care.  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

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