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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.

Paediatrics - all drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

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02.08.02  Expand sub section  Oral anticoagulants
 note  In paediatrics only warfarin is used as an anticoagulant
Warfarin tablets
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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
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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
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Formulary
Green
10mg, 25mg, 50mg

Paediatrics: only warfarin is used in paediatrics 
   
Apixaban tablets
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Formulary
Green
2.5mg, 5mg
Prevention of stroke and systemic embolism in atrial fibrillation.

Paediatrics: only warfarin is used in paediatrics 
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
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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)
   
Apixaban tablets
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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
   
Dabigatran capsules
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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
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
Green
75mg, 110mg, 150mg
Prevention of stroke and systemic embolism in atrial fibrillation.

Paediatrics: only warfarin is used in paediatrics 
Link  DABIGATRAN (Pradaxa®▼) in Atrial Fibrillation Pan Mersey Area Prescribing Committee Policy Statement
Link  NICE TA249: Dabigatran for Stroke prevention in AF
   
Edoxaban tablets
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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 
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
   
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 
Link  NICE TA256: Rivaroxaban for AF
Link  RIVAROXABAN (Xarelto®) in Atrial Fibrillation Pan Mersey Area Prescribing Committee Policy Statement
   
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  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  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
Link  RIVAROXABAN tablets (Xarelto®▼) in Acute Coronary Syndrome Pan Mersey Area Prescribing Committee Prescribing Policy Statement
   
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  NICE TA170: 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 
   
 ....
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

Amber Recommended  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose and the patient’s condition 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 and the patient’s condition 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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