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Cardiovascular system
Cardiovascular system / Patent ductus arteriosus
  alprostadil Hospital Only
ALPROSTADIL

For patent ductus arteriosus - please refer to children's BNF

  Powder and solvent for solution for injection
Caverject (Pfizer Ltd)
Viridal (Advanz Pharma)
  Stick
Muse (Viatris UK Healthcare Ltd)
  Cutaneous cream
Vitaros (The Simple Pharma Company UK Ltd)
  dinoprostone Hospital Only
Patent ductus arteriosus

For patent ductus arteriosus - please refer to children's BNF

  Pessary
Prostin E2 (Pfizer Ltd)
  Vaginal device
Propess (Ferring Pharmaceuticals Ltd)
Propess®

WHIPPS CROSS- First line for outpatient induction of labour in low risk women

NEWHAM- Second line for inpatient induction of labour

  Vaginal gel
Prostin E2 (Pfizer Ltd) Hospital Only
  ibuprofen
Patent ductus arteriosus

For patent ductus arteriosus - please refer to children's BNF

  Orodispersible tablet
Nurofen Meltlets (Reckitt Benckiser Healthcare (UK) Ltd)
  Modified-release tablet
Brufen Retard (Viatris UK Healthcare Ltd)
  Chewable capsule
Nurofen (Reckitt Benckiser Healthcare (UK) Ltd)
  Modified-release capsule
Ibuprofen (Non-proprietary)
Galprofen Long Lasting (Galpharm International Ltd)
Nurofen Long Lasting (Reckitt Benckiser Healthcare (UK) Ltd)
  Effervescent granules
Brufen (Viatris UK Healthcare Ltd)
  Oral suspension
Ibuprofen (Non-proprietary)
Brufen (Viatris UK Healthcare Ltd)
Nurofen (Reckitt Benckiser Healthcare (UK) Ltd)
  Solution for infusion
Ibuprofen (Non-proprietary)
Pedea (Recordati Rare Diseases UK Ltd)
  Oral tablet
Ibuprofen (Non-proprietary)
Brufen (Viatris UK Healthcare Ltd)
Feminax Express (Bayer Plc)
Nurofen (Reckitt Benckiser Healthcare (UK) Ltd)
Nurofen Express (Reckitt Benckiser Healthcare (UK) Ltd)
Nurofen Joint & Back Pain Relief (Reckitt Benckiser Healthcare (UK) Ltd)
Nurofen Migraine Pain (Reckitt Benckiser Healthcare (UK) Ltd)
  Oral capsule
Ibuprofen (Non-proprietary)
Flarin (infirst Ltd)
Nurofen Express (Reckitt Benckiser Healthcare (UK) Ltd)
  Cutaneous gel
Ibuprofen (Non-proprietary)
Ibugel (Dermal Laboratories Ltd)
Ibuleve (Diomed Developments Ltd)
Phorpain (Advanz Pharma)
Cardiovascular system / Arrhythmias
  Hydroquinidine Hospital Only
  VERNAKALANT Hospital Only
Approved in August 2017 DTC

For rapid conversion of new onset atrial fibrillation ≤ 3 days duration in adult post-cardiac surgery patients

 

Approved for use in line with approved audit protocol for 100 patients only

The applicants had submitted the audit protocol for this drug, as approved by the Trust's Clinical Effectiveness Department. Outcome measures included:
- Rate of return to stable sinus rhythm, and total atrial fibrillation load while in hospital (percentage of time the patient is in atrial fibrillation).
- Time spent on ICU.
- Reinsertion of central venous line to manage arrhythmia.
- Time spent in hospital.

The Chair had authorised the drug's addition to the Trust's Formulary as soon as this protocol had been received, as agreed at the previous meeting.

  acebutolol Off Formulary
  Oral tablet
Acebutolol (Non-proprietary)
  adenosine Hospital Only
ADENOSINE

HOSPITAL ONLY

Adenosine 1mg/ml infusion

Adenosine 1mg/ml solution available for stress testing in imaging and measurement of FFR in cath labs

  Solution for injection
Adenosine (Non-proprietary) On Formulary
Adenocor (Sanofi) On Formulary
  Solution for infusion
Adenosine (Non-proprietary) On Formulary
Adenoscan (Sanofi) On Formulary
  amiodarone hydrochloride On Formulary
AMIODARONE HYDROCHLORIDE

For supraventricular or ventricular arrythmias.
Specialist initiation.
Need to monitor LFTs and TFT as a baseline and at follow ups.

INJECTION IS HOSPITAL ONLY


https://www.nice.org.uk/guidance/cg180

 Please see primary care prescriber information factsheet below for GPs

  Solution for injection
Amiodarone hydrochloride (Non-proprietary) On Formulary
Amiodarone

INJECTION IS HOSPITAL ONLY

Cordarone X (Sanofi) On Formulary
  Oral tablet
Amiodarone hydrochloride (Non-proprietary)
  atenolol On Formulary
  Oral solution
Atenolol (Non-proprietary)
  Solution for injection
Tenormin (Atnahs Pharma UK Ltd) Off Formulary
  Oral tablet
Atenolol (Non-proprietary)
Tenormin (Atnahs Pharma UK Ltd)
  atropine sulfate Hospital Only
ATROPINE SULFATE

Hospital-Only Drug

  Solution for injection
Atropine sulfate (Non-proprietary) Hospital Only
  Eye drops
Atropine sulfate (Non-proprietary)
  digoxin On Formulary
  Oral solution
Digoxin (Non-proprietary)
  Solution for injection
Digoxin (Non-proprietary) Hospital Only
  Solution for infusion
Digoxin (Non-proprietary)
  Oral tablet
Digoxin (Non-proprietary)
  disopyramide On Formulary
Obstructive hypertrophic cardiomyopathy

Used for symptom relief in obstructive hypertrophic cardiomyopathy under specialist initiation and monitoring

  Modified-release tablet
Rythmodan Retard (Neon Healthcare Ltd) On Formulary
  Oral capsule
Rythmodan (Neon Healthcare Ltd)
  dronedarone On Formulary NICE TA197
DRONEDARONE

Specialist initiation.  To be initiated by hospital and continued by GPs. Please see prescribing information sheet below.

Dronedarone is recommended as an option for the maintenance of sinus rhythm after successful cardioversion in people with paroxysmal or persistent atrial fibrillation:

whose atrial fibrillation is not controlled by first-line therapy (usually including betablockers), that is, as a second-line treatment option and after alternative options have been considered and who have at least 1 of the following cardiovascular risk factors:

- hypertension requiring drugs of at least 2 different classes

- diabetes mellitus

- previous transient ischaemic attack, stroke or systemic embolism

- left atrial diameter of 50mm or greater or

- age 70 years or older and

- who do not have left ventricular systolic dysfunction and

- who do not have a history of, or current, heart failure (NYHA Class III/IV).

 


 Should have baseline U&Es, LFTs and QTc level prior to intitiation.
 https://www.nice.org.uk/guidance/ta197
 
http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON131928

  Oral tablet
Dronedarone (Non-proprietary)
Multaq (Sanofi)
  esmolol hydrochloride Hospital Only
  Solution for injection
Esmolol hydrochloride (Non-proprietary) Hospital Only
Brevibloc (Baxter Healthcare Ltd) Hospital Only
  Solution for infusion
Esmolol hydrochloride (Non-proprietary)
Brevibloc (Baxter Healthcare Ltd)
  flecainide acetate On Formulary
FLECAINIDE ACETATE

For injection HOSPITAL ONLY- unlicensed- see medusa for administration

For Oral on formulary

  Oral tablet
Flecainide acetate (Non-proprietary)
  landiolol hydrochloride
  Powder for solution for infusion
Rapibloc (AOP Orphan Ltd)
  lidocaine hydrochloride Hospital Only
  Solution for injection
Lidocaine hydrochloride (Non-proprietary) Hospital Only
  Ointment
Lidocaine hydrochloride (Non-proprietary)
  Spray
Stud 100 (Pound International Ltd)
Xylocaine (Aspen Pharma Trading Ltd)
Approved for IUD insertion in GUM clinics- Hospital Only

Approved at March DTC 2022

  Medicated plaster
Lidocaine hydrochloride (Non-proprietary)
Ralvo (Grunenthal Ltd) Off Formulary
Versatis (Grunenthal Ltd) Off Formulary
Versatis®

For treatment of neuropathic pain-see section 4.7.3

  Cutaneous cream
LMX 4 (Ferndale Pharmaceuticals Ltd)
Vagisil medicated (Combe International Ltd)
  metoprolol tartrate On Formulary
METOPROLOL TARTRATE

Initiation for atrial fibrillation, hypertension, secondary prevention of MI, heart failure, stable angina.

Note: Metoprolol initiated until stable and then changed to a less frequent dosage regime.

Alternative for hypertension in pregnancy.

https://www.nice.org.uk/guidance/ng185

https://www.nice.org.uk/guidance/ng196

https://www.nice.org.uk/guidance/ng133

https://www.nice.org.uk/guidance/cg126

 

 

  Solution for injection
Betaloc (Recordati Pharmaceuticals Ltd) Hospital Only
  Oral tablet
Metoprolol tartrate (Non-proprietary)
  mexiletine NICE TA748
  Oral capsule
Mexiletine (Non-proprietary)
Namuscla (Lupin Healthcare (UK) Ltd)
  nadolol On Formulary
  Oral tablet
Nadolol (Non-proprietary)
  propafenone hydrochloride On Formulary
  Oral tablet
Propafenone hydrochloride (Non-proprietary)
Arythmol (Viatris UK Healthcare Ltd)
  propranolol hydrochloride On Formulary
PROPRANOLOL HYDROCHLORIDE

Phaechromocytoma (usually started 24 hours after Phenoxybenzamine)

Also used orally for cutaneous haemangioma where topical timolol not appropriate.

For use in the management of acute alcohol withdrawal-see 'Alcohol dependence https://www.formularycomplete.com/view/treatmentsummary/monograph/848264 

PROPRANOLOL for thyrotoxicosis

Symptomatic relief of thyrotoxicosis-

  Modified-release capsule
Bedranol SR (Almus Pharmaceuticals Ltd, Sandoz Ltd)
Propranolol

Whipps Cross: somatic manifestations of acute alcohol withdrawal-  see alcohol dependance for more information
 

Beta-Prograne (Accord-UK Ltd, Tillomed Laboratories Ltd)
Half Beta-Prograne (Accord-UK Ltd, Tillomed Laboratories Ltd)
  Oral solution
Propranolol hydrochloride (Non-proprietary) On Formulary
  Oral tablet
Propranolol hydrochloride (Non-proprietary)
  sotalol hydrochloride On Formulary
SOTALOL HYDROCHLORIDE

Specialist initiation.
Life-threatening arrythmias. 
Measure QT interval after initiation and following dose increases.

  Oral tablet
Sotalol hydrochloride (Non-proprietary)
  verapamil hydrochloride On Formulary
VERAPAMIL HYDROCHLORIDE

For rate controlled angina.
 

 
Atrial fibrillation

https://www.nice.org.uk/guidance/ng196

Stable angina 

https://www.nice.org.uk/guidance/cg126

  Modified-release tablet
Half Securon (Viatris UK Healthcare Ltd) On Formulary
Securon SR (Viatris UK Healthcare Ltd) On Formulary
Vera-Til SR (Accord-UK Ltd, Tillomed Laboratories Ltd) On Formulary
Verapress MR (Dexcel-Pharma Ltd) On Formulary
  Oral solution
Verapamil hydrochloride (Non-proprietary) On Formulary
  Solution for injection
Securon (Viatris UK Healthcare Ltd) Hospital Only
  Oral tablet
Verapamil hydrochloride (Non-proprietary)
  vernakalant Hospital Only
Local protocol in post surgical patients (SBH)

Approved in August 2017 DTC

 

For rapid conversion of new onset atrial fibrillation ≤ 3 days duration in adult post-cardiac surgery patients

 

Approved for use in line with approved audit protocol for 100 patients only

The applicants had submitted the audit protocol for this drug, as approved by the Trust's Clinical Effectiveness Department. Outcome measures included:
- Rate of return to stable sinus rhythm, and total atrial fibrillation load while in hospital (percentage of time the patient is in atrial fibrillation).
- Time spent on ICU.
- Reinsertion of central venous line to manage arrhythmia.
- Time spent in hospital.

The Chair had authorised the drug's addition to the Trust's Formulary as soon as this protocol had been received, as agreed at the previous meeting.

  Solution for infusion
Brinavess (Advanz Pharma)
Cardiovascular system / Hypertension
  acebutolol Off Formulary
  Oral tablet
Acebutolol (Non-proprietary)
  aliskiren Off Formulary
ALISKIREN

Specialist initiation only.

This is a fourth-line option after considering alpha-blockers, potassium sparing diuretics or aldosterone antagonists.

Please read MHRA alert - risk of cardiovascular and renal reactions.

http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON146526


  Oral tablet
Rasilez (Noden Pharma DAC)
  amiloride hydrochloride On Formulary
AMILORIDE HYDROCHLORIDE

 Usually in conjunction with furosemide (co-amilofruse) to maintain K+ while on diuretic treament.
 

  Oral solution
Amiloride hydrochloride (Non-proprietary) On Formulary
  Oral tablet
Amiloride hydrochloride (Non-proprietary)
  amlodipine On Formulary
AMLODIPINE

First-line dihydropyridine calcium channel blocker for hypertension.  

Can be considered for stable angina.

Stable Angina guidelines
 
https://www.nice.org.uk/guidance/cg126
 
Hypertension guidelines


https://www.nice.org.uk/guidance/ng136


 

  Oral suspension
Amlodipine (Non-proprietary) Hospital Only
Liquid prep- hospital only

Liquid prep to be used on the advice of clinical pharmacologist

  Oral solution
Amlodipine (Non-proprietary)
  Oral tablet
Amlodipine (Non-proprietary)
Istin (Viatris UK Healthcare Ltd)
  amlodipine with valsartan Off Formulary
  Oral tablet
Amlodipine with valsartan (Non-proprietary)
Exforge (Novartis Pharmaceuticals UK Ltd)
  atenolol On Formulary
  Oral solution
Atenolol (Non-proprietary)
  Solution for injection
Tenormin (Atnahs Pharma UK Ltd) Off Formulary
  Oral tablet
Atenolol (Non-proprietary)
Tenormin (Atnahs Pharma UK Ltd)
  azilsartan medoxomil Off Formulary
  Oral tablet
Edarbi (Takeda UK Ltd)
  bendroflumethiazide On Formulary
Hypertension

NICE hypertension guidance: https://www.nice.org.uk/guidance/ng136

If starting or changing diuretic treatment for hypertension, offer a thiazide-like diuretic, such as indapamide in preference to a conventional thiazide diuretic such as bendroflumethiazide or hydrochlorothiazide.

For adults with hypertension already having treatment with bendroflumethiazide or hydrochlorothiazide, who have stable, well-controlled blood pressure, continue with their current treatment.

Resistant oedema associated with heart failure

In the management of diuretic resistance, if metolazone is unavailable (only available as import): bendroflumethiazide can be used with loop diuretics for resistant oedema associated with heart failure.

 

 

  Oral tablet
Bendroflumethiazide (Non-proprietary)
  bisoprolol fumarate On Formulary
BISOPROLOL FUMARATE

First-line for heart failure, atrial fibrillation, secondary prevention of MI and stable angina.  
 
Mild to moderate COPD is not a contraindication for use of cardioselective beta blockers such as bisoprolol.
https://www.nice.org.uk/guidance/ng106

https://www.nice.org.uk/guidance/ng136

https://www.nice.org.uk/guidance/ng185

https://www.nice.org.uk/guidance/ng196

https://www.nice.org.uk/guidance/cg126

  Oral tablet
Bisoprolol fumarate (Non-proprietary)
Cardicor (Merck Serono Ltd)
  candesartan cilexetil On Formulary
CANDESARTAN CILEXETIL

Can be used if intolerant to ACE Inhibitor - cough for instance.  Can be used for Heart Failure, post-MI or hypertension

Heart Failure Guidelines
 
https://www.nice.org.uk/guidance/ng106
 
Hypertension Guidelines
 

Secondary prevention of MI Guidelines
 

  Oral tablet
Candesartan cilexetil (Non-proprietary)
Amias (Neon Healthcare Ltd)
  captopril On Formulary
  Oral solution
Captopril (Non-proprietary)
  Oral tablet
Captopril (Non-proprietary)
  carvedilol On Formulary
CARVEDILOL

Can be used as second-line beta blocker (after bisoprolol) for heart failure, atrial fibrillation, hypertension, secondary prevention of MI and stable angina.

  Oral tablet
Carvedilol (Non-proprietary)
  celiprolol hydrochloride Off Formulary
Vascular Ehlers Danlos Syndrome (vEDS)

On Formulary for vascular Ehlers Danlos Syndrome - approved at July 2021 Drugs and Therapeutics Committee.

Starting dose 100mg daily, titrated up to 400mg daily as directed.

  Oral tablet
Celiprolol hydrochloride (Non-proprietary)
Celectol (Neon Healthcare Ltd)
  chlortalidone On Formulary
CHLORTALIDONE

Second-line for hypertension as per NICE - Barts Health uses indapamide as first-line choice for a thiazide-like diuretic.

http://guidance.nice.org.uk/CG127/QuickRefGuide/pdf/English

  Oral tablet
Chlortalidone (Non-proprietary)
Hylaton (Morningside Healthcare Ltd)
  clonidine hydrochloride Hospital Only
CLONIDINE HYDROCHLORIDE

Not routinely used for headache.

Sometimes used for hypertension.

Also for sedation in critical care areas mainly.

February 2024- Clonidine transdermal patches for dystonia in paediatrics (unlicensed)

Clonidine transdermal patches approved at NEL FPG for dystonia in paediatrics (unlicensed).

For severe dystonia in patients who could not be adequately managed on oral medications either due to side effects from
higher doses or the burden of increased frequency of dosing administered by carers and families

 

Formulary Status: Hospital Only

Clonidine tapering of dose

Clonidine is used for agitation in critical care areas. 
Once a patient has been transferred from critical care to a ward, clonidine should be weaned off as tolerated, with the aim of discontinuing it before discharge from hospital.  
The timescale depends on the duration of clonidine therapy, as follows:
Less than one week: 24-48h
One week to one month: 5 days
More than one month: 2 weeks

Clonidine for ADHD

Hospital only for ADHD

Clonidine Patches 0.1, 0.2 and 0.3mg/day (unlicensed in UK)

Clonidine Patches are for specialist initation only within the hypertension clinic. These are used for the  treatment of hypertension where the oral route is inappropriate or there is a lactose allergy to tablets. Doses are initated and titrated within clinic.

  Oral solution
Clonidine hydrochloride (Non-proprietary)
  Oral tablet
Clonidine hydrochloride (Non-proprietary)
Catapres (Glenwood GmbH)
  co-amilozide Off Formulary
  Oral tablet
Co-amilozide (Non-proprietary)
  co-tenidone Off Formulary
  Oral tablet
Co-tenidone (Non-proprietary)
Tenoret (Atnahs Pharma UK Ltd)
Tenoretic (Atnahs Pharma UK Ltd)
  diltiazem hydrochloride On Formulary
DILTIAZEM HYDROCHLORIDE

 
***Please specify the BRAND NAME as there are differences in bioavailability***

Secondary prevention of MI

http://www.nice.org.uk/Guidance/CG48

Atrial fibrillation

http://www.nice.org.uk/guidance/cg180

Stable angina

http://www.nice.org.uk/guidance/CG126

  Modified-release tablet
Diltiazem hydrochloride (Non-proprietary) On Formulary
Retalzem (Kent Pharma (UK) Ltd)
Tildiem (Sanofi)
Tildiem Retard (Sanofi)
Zeyam (Ennogen Pharma Ltd)
  Modified-release capsule
Adizem-SR (Napp Pharmaceuticals Ltd)
Adizem-XL (Napp Pharmaceuticals Ltd)
Angitil SR (Ethypharm UK Ltd)
Angitil XL (Ethypharm UK Ltd)
Slozem (Zentiva Pharma UK Ltd)
Tildiem LA (Sanofi)
Viazem XL (Thornton & Ross Ltd)
Zemtard XL (Galen Ltd)
  doxazosin On Formulary
DOXAZOSIN

Last line option for hypertension except in renal patients.

Treatment option for BPH at Barts Health.

DOXAZOSIN

http://www.nice.org.uk/guidance/CG127

  Modified-release tablet
Cardura XL (Viatris UK Healthcare Ltd) Off Formulary
Doxadura XL (Dexcel-Pharma Ltd) Off Formulary
Larbex XL (Teva UK Ltd) Off Formulary
Raporsin XL (Accord-UK Ltd) Off Formulary
  Oral tablet
Doxazosin (Non-proprietary)
Cardura (Viatris UK Healthcare Ltd)
Doxadura (Dexcel-Pharma Ltd)
  enalapril maleate On Formulary
  Oral solution
Enalapril maleate (Non-proprietary)
  Oral tablet
Enalapril maleate (Non-proprietary)
Innovace (Organon Pharma (UK) Ltd)
  enalapril with hydrochlorothiazide Off Formulary
  Oral tablet
Enalapril with hydrochlorothiazide (Non-proprietary)
Innozide (Organon Pharma (UK) Ltd)
  eprosartan Off Formulary
  Oral tablet
Eprosartan (Non-proprietary)
Teveten (Viatris UK Healthcare Ltd)
  esmolol hydrochloride Hospital Only
  Solution for injection
Esmolol hydrochloride (Non-proprietary) Hospital Only
Brevibloc (Baxter Healthcare Ltd) Hospital Only
  Solution for infusion
Esmolol hydrochloride (Non-proprietary)
Brevibloc (Baxter Healthcare Ltd)
  felodipine On Formulary
  Modified-release tablet
Cardioplen XL (Chiesi Ltd)
Delofine XL (Morningside Healthcare Ltd)
Felendil XL (Teva UK Ltd)
Felotens XL (Thornton & Ross Ltd)
Neofel XL (Kent Pharma (UK) Ltd)
Parmid XL (Sandoz Ltd)
Pinefeld XL (Tillomed Laboratories Ltd)
Vascalpha (Accord-UK Ltd)
  fosinopril sodium Off Formulary
  Oral tablet
Fosinopril sodium (Non-proprietary)
  furosemide On Formulary
FUROSEMIDE

First line for treating fluid accumulation associtated with heart failure.


https://www.nice.org.uk/guidance/ng106

 

  Oral solution
Furosemide (Non-proprietary) On Formulary
Agreed standard strength for paediatrics

Furosemide

40mg/5ml should be used in adults only

50mg/5ml should be used for all paediatric doses 1mg or greater

20mg/5ml is reserved for Neonatal doses <1mg

Frusol (Rosemont Pharmaceuticals Ltd)
  Solution for injection
Furosemide (Non-proprietary) On Formulary
  Oral tablet
Furosemide (Non-proprietary)
  hydralazine hydrochloride On Formulary
HYDRALAZINE HYDROCHLORIDE

IV FORMULATION IS FOR HOSPITAL USE ONLY

  Powder for solution for injection
Hydralazine hydrochloride (Non-proprietary)
  Oral tablet
Hydralazine hydrochloride (Non-proprietary)
Apresoline (Advanz Pharma)
  hydrochlorothiazide
  imidapril hydrochloride Off Formulary
  Oral tablet
Tanatril (Northumbria Pharma Ltd)
  indapamide On Formulary
INDAPAMIDE

 
First-line thiazide-like diuretic for hypertension.

https://pathways.nice.org.uk/pathways/hypertension

  Modified-release tablet
Indapamide (Non-proprietary)
Alkapamid XL (HBS Healthcare Ltd)
Cardide SR (Teva UK Ltd)
Lorvacs XL (Torrent Pharma (UK) Ltd)
Natrilix SR (Servier Laboratories Ltd)
  Oral tablet
Indapamide (Non-proprietary)
Natrilix (Servier Laboratories Ltd)
  indoramin On Formulary
  Oral tablet
Indoramin (Non-proprietary)
Doralese Tiltab (Essential Generics Ltd)
  irbesartan On Formulary
IRBESARTAN

Renal patients: Hypertension or post MI and heart failure.

Heart Failure Guidelines
 

 
Secondary prevention of MI Guidelines
 

  Oral tablet
Irbesartan (Non-proprietary)
Aprovel (Sanofi)
Ifirmasta (Krka UK Ltd)
  irbesartan with hydrochlorothiazide
  Oral tablet
Irbesartan with hydrochlorothiazide (Non-proprietary)
CoAprovel (Sanofi)
  labetalol hydrochloride On Formulary
LABETALOL HYDROCHLORIDE

First line for management of hypertension in pregnancy.

http://publications.nice.org.uk/hypertension-in-pregnancy-cg107

Please note: The injection is HOSPITAL ONLY.

  Solution for injection
Labetalol hydrochloride (Non-proprietary) On Formulary
Labetalol Hydrochloride

Please note: The injection is HOSPITAL ONLY.

  Oral tablet
Labetalol hydrochloride (Non-proprietary)
Trandate (RPH Pharmaceuticals AB)
  lacidipine On Formulary
  Oral tablet
Lacidipine (Non-proprietary)
Molap (Rivopharm (UK) Ltd)
Motens (GlaxoSmithKline UK Ltd)
  lercanidipine hydrochloride On Formulary
  Oral tablet
Lercanidipine hydrochloride (Non-proprietary)
Zanidip (Recordati Pharmaceuticals Ltd)
  lisinopril On Formulary
LISINOPRIL

Heart Failure Guidelines

https://www.nice.org.uk/guidance/ng106

 
Hypertension Guidelines
 
 

Secondary prevention of MI Guidelines
 

  Oral solution
Lisinopril (Non-proprietary) On Formulary
  Oral tablet
Lisinopril (Non-proprietary)
Zestril (Atnahs Pharma UK Ltd)
  lisinopril with hydrochlorothiazide On Formulary
  Oral tablet
Lisinopril with hydrochlorothiazide (Non-proprietary)
Lisoretic (Bristol Laboratories Ltd)
Zestoretic (Atnahs Pharma UK Ltd)
  losartan potassium On Formulary
LOSARTAN POTASSIUM

Heart Failure Guidelines
 https://www.nice.org.uk/guidance/ng106

 
Hypertension Guidelines

https://pathways.nice.org.uk/pathways/hypertension

 
Secondary prevention of MI Guidelines
 

  Oral tablet
Losartan potassium (Non-proprietary)
Cozaar (Organon Pharma (UK) Ltd)
  losartan with hydrochlorothiazide On Formulary
  Oral tablet
Losartan with hydrochlorothiazide (Non-proprietary)
Cozaar-Comp (Organon Pharma (UK) Ltd)
  methyldopa On Formulary
METHYLDOPA

First line treatment of hypertension in pregancy.

http://publications.nice.org.uk/hypertension-in-pregnancy-cg107

  Oral tablet
Methyldopa (Non-proprietary)
  metolazone Off Formulary
METOLAZONE

If metolazone available:
Used in renal patients for the treatment of oedema

Switching to the UK licensed preparation of Xaqua®(metolazone) 5mg tablets, May 2023

The Trust switched to the UK licensed preparation of Xaqua®(metolazone) 5mg tablets for all areas across the Trust. 

Metolazone caution with loop diuretics

Metolazone is a potent diuretic and when used with loop diuretics can cause a dramatic diuresis and disturbance to fluid balance and electrolytes due to sequential blockade of the nephron. Patients must be closely monitored and this combination should only be initiated by specialists with experience of using this combination e.g. cardiology or renal teams.  Any patient discharged on the combination should have an outpatient follow-up appointment within two weeks.

Dosage and adminstration when used in combination with loop diuretics:
Starting dose: 2.5 mg on alternate days or daily
Titrate by 2.5mg dose increments according to response
Maximum dose: 7.5mg once daily

NOTE: Unlicensed

  Oral tablet
Metolazone (Non-proprietary)
Xaqua (Renascience Pharma Ltd)
  metoprolol tartrate On Formulary
METOPROLOL TARTRATE

Initiation for atrial fibrillation, hypertension, secondary prevention of MI, heart failure, stable angina.

Note: Metoprolol initiated until stable and then changed to a less frequent dosage regime.

Alternative for hypertension in pregnancy.

https://www.nice.org.uk/guidance/ng185

https://www.nice.org.uk/guidance/ng196

https://www.nice.org.uk/guidance/ng133

https://www.nice.org.uk/guidance/cg126

 

 

  Solution for injection
Betaloc (Recordati Pharmaceuticals Ltd) Hospital Only
  Oral tablet
Metoprolol tartrate (Non-proprietary)
  minoxidil On Formulary
  Cutaneous solution
Regaine (Johnson & Johnson Ltd, McNeil Products Ltd)
  Cutaneous foam
Regaine (McNeil Products Ltd)
Regaine for Women Once a Day (McNeil Products Ltd)
  Oral tablet
Minoxidil (Non-proprietary)
Loniten (Pfizer Ltd)
  moxonidine On Formulary
MOXONIDINE

For hypertension.

Should be initiated by a specialist only.

Last line option.
 

  Oral tablet
Moxonidine (Non-proprietary)
Physiotens (Viatris UK Healthcare Ltd)
  nadolol Off Formulary
  Oral tablet
Nadolol (Non-proprietary)
  nebivolol On Formulary
NEBIVOLOL

Specialist initiation with PEFR monitoring in hospital. (NB: mild to moderate COPD is not a contraindication for use of other cardioselective beta blockers)

Highly cardioselective beta blocker.

Can be initiated at 1.25mg (quarter of a 5mg tablet) can be considered in patients with severe asthma or COPD.

  Oral tablet
Nebivolol (Non-proprietary)
Nebilet (A. Menarini Farmaceutica Internazionale SRL)
  nicardipine hydrochloride On Formulary
  Solution for infusion
Nicardipine hydrochloride (Non-proprietary) Hospital Only
  Oral capsule
Cardene (Laboratoire X.O)
  nifedipine On Formulary
Leiomyoma pain

Nidfedipine 10-20mg daily or twice daily is used in dermatology for pain resulting from leiomyoma

  Modified-release tablet
Adalat LA (Bayer Plc) On Formulary
Leiomyoma pain

Nidfedipine 10-20mg daily or twice daily is used in dermatology for pain resulting from leiomyoma

Adanif XL (Advanz Pharma)
Adipine MR (Chiesi Ltd)
Adipine XL (Chiesi Ltd)
Dexipress MR (Dexcel-Pharma Ltd)
Fortipine LA (Advanz Pharma)
Neozipine XL (Kent Pharma (UK) Ltd)
Nifedipress MR (Dexcel-Pharma Ltd)
Tensipine MR (Genus Pharmaceuticals Ltd)
Valni Retard (Tillomed Laboratories Ltd)
  Modified-release capsule
Coracten SR (Teofarma S.r.l.)
Coracten XL (Teofarma S.r.l.)
  Oral drops
Nifedipine (Non-proprietary)
  Oral capsule
Nifedipine (Non-proprietary)
  olmesartan medoxomil Off Formulary
  Oral tablet
Olmesartan medoxomil (Non-proprietary)
Olmetec (Daiichi Sankyo UK Ltd)
  olmesartan with amlodipine Off Formulary
  Oral tablet
Sevikar (Daiichi Sankyo UK Ltd)
  olmesartan with amlodipine and hydrochlorothiazide On Formulary
  Oral tablet
Sevikar HCT (Daiichi Sankyo UK Ltd)
  olmesartan with hydrochlorothiazide Off Formulary
  Oral tablet
Olmesartan with hydrochlorothiazide (Non-proprietary)
Olmetec Plus (Daiichi Sankyo UK Ltd)
  perindopril arginine Off Formulary
  Oral tablet
Coversyl Arginine (Servier Laboratories Ltd)
  perindopril arginine with indapamide
  Oral tablet
Coversyl Arginine Plus (Servier Laboratories Ltd)
  perindopril erbumine On Formulary
PERINDOPRIL ERBUMINE

Heart Failure Guidelines
 
https://www.nice.org.uk/guidance/ng106
 
Hypertension Guidelines
 
https://pathways.nice.org.uk/pathways/hypertension
 
Secondary prevention of MI Guidelines
 

  Oral tablet
Perindopril erbumine (Non-proprietary)
  perindopril erbumine with amlodipine
  pindolol Off Formulary
  prazosin Off Formulary
  Oral tablet
Prazosin (Non-proprietary)
Hypovase (Pfizer Ltd)
  propranolol hydrochloride On Formulary
PROPRANOLOL HYDROCHLORIDE

Phaechromocytoma (usually started 24 hours after Phenoxybenzamine)

Also used orally for cutaneous haemangioma where topical timolol not appropriate.

For use in the management of acute alcohol withdrawal-see 'Alcohol dependence https://www.formularycomplete.com/view/treatmentsummary/monograph/848264 

PROPRANOLOL for thyrotoxicosis

Symptomatic relief of thyrotoxicosis-

  Modified-release capsule
Bedranol SR (Almus Pharmaceuticals Ltd, Sandoz Ltd)
Propranolol

Whipps Cross: somatic manifestations of acute alcohol withdrawal-  see alcohol dependance for more information
 

Beta-Prograne (Accord-UK Ltd, Tillomed Laboratories Ltd)
Half Beta-Prograne (Accord-UK Ltd, Tillomed Laboratories Ltd)
  Oral solution
Propranolol hydrochloride (Non-proprietary) On Formulary
  Oral tablet
Propranolol hydrochloride (Non-proprietary)
  quinapril Off Formulary
  Oral tablet
Quinapril (Non-proprietary)
Accupro (Pfizer Ltd)
  quinapril with hydrochlorothiazide Off Formulary
  Oral tablet
Accuretic (Pfizer Ltd)
  ramipril On Formulary
RAMIPRIL

First-line ACEI for hypertension, heart failure, secondary prevention of MI.

Heart Failure Guidelines

https://www.nice.org.uk/guidance/ng106
 
Hypertension Guidelines
 
https://pathways.nice.org.uk/pathways/hypertension
 
Secondary prevention of MI Guidelines 

https://pathways.nice.org.uk/pathways/myocardial-infarction-rehabilitation-and-preventing-further-cardiovascular-disease

  Oral solution
Ramipril (Non-proprietary) On Formulary
RAMIPRIL

First-line ACEI for hypertension, heart failure, secondary prevention of MI.

Heart Failure Guidelines

http://www.nice.org.uk/guidance/cg108

Hypertension Guidelines

http://www.nice.org.uk/guidance/CG127

Secondary prevention of MI Guidelines

http://www.nice.org.uk/guidance/cg172

  Oral tablet
Ramipril (Non-proprietary)
Tritace (Sanofi)
  Oral capsule
Ramipril (Non-proprietary)
  ramipril with felodipine Off Formulary
  spironolactone On Formulary
SPIRONOLACTONE

Hypertension: Consider further diuretic therapy with low-dose spironolactone (25 mg once daily)  if the blood potassium level is 4.5 mmol/l or lower. Use particular caution in people with a reduced estimated glomerular filtration rate because they have an increased risk of hyperkalaemia. NICE CG 127

Heart failure: with preserved ejection fraction as determined by specialist.  NICE CG 108

Ascites, nephrotic syndrome, Conn's syndrome (300mg-600mg per day)

Doses above 100mg daily may be associated with impotence in males.

  Oral solution
Spironolactone (Non-proprietary)
  Oral tablet
Spironolactone (Non-proprietary)
Aldactone (Pfizer Ltd)
  telmisartan Off Formulary
  Oral tablet
Telmisartan (Non-proprietary)
Micardis (Boehringer Ingelheim Ltd)
  telmisartan with hydrochlorothiazide Off Formulary
  Oral tablet
Telmisartan with hydrochlorothiazide (Non-proprietary)
MicardisPlus (Boehringer Ingelheim Ltd)
MicardisPlus 80/25 (Boehringer Ingelheim Ltd)
Tolucombi (Krka UK Ltd)
  terazosin Off Formulary
  Form unstated
Hytrin (Advanz Pharma)
  Oral tablet
Terazosin (Non-proprietary)
Hytrin (Advanz Pharma)
  timolol maleate Off Formulary
  Eye drops
Timolol maleate (Non-proprietary)
Eysano (Aspire Pharma Ltd)
Timoptol (Santen UK Ltd)
Tiopex (Thea Pharmaceuticals Ltd)
Once-daily preparations

Long acting preparations of timolol are used in dermatology for cutaneous haemangioma

  Eye gel
Timoptol-LA (Santen UK Ltd)
  Oral tablet
Timolol maleate (Non-proprietary)
  timolol with bendroflumethiazide Off Formulary
  Oral tablet
Timolol with bendroflumethiazide (Non-proprietary)
  torasemide Off Formulary
  Oral tablet
Torasemide (Non-proprietary)
Torem (Viatris UK Healthcare Ltd)
  trandolapril Off Formulary
  Oral capsule
Trandolapril (Non-proprietary)
  triamterene with chlortalidone Off Formulary
  Oral tablet
Triamterene with chlortalidone (Non-proprietary)
  valsartan On Formulary
VALSARTAN

Last-line option post-MI

Heart Failure Guidelines
 
https://www.nice.org.uk/guidance/ng106
 
Hypertension Guidelines
 
https://pathways.nice.org.uk/pathways/hypertension
 
Secondary prevention of MI Guidelines
 

  Oral solution
Diovan (Novartis Pharmaceuticals UK Ltd)
  Oral tablet
Valsartan (Non-proprietary)
  Oral capsule
Valsartan (Non-proprietary)
  valsartan with hydrochlorothiazide Off Formulary
  Oral tablet
Valsartan with hydrochlorothiazide (Non-proprietary)
Co-Diovan (Novartis Pharmaceuticals UK Ltd)
  verapamil hydrochloride On Formulary
VERAPAMIL HYDROCHLORIDE

For rate controlled angina.
 

 
Atrial fibrillation

https://www.nice.org.uk/guidance/ng196

Stable angina 

https://www.nice.org.uk/guidance/cg126

  Modified-release tablet
Half Securon (Viatris UK Healthcare Ltd) On Formulary
Securon SR (Viatris UK Healthcare Ltd) On Formulary
Vera-Til SR (Accord-UK Ltd, Tillomed Laboratories Ltd) On Formulary
Verapress MR (Dexcel-Pharma Ltd) On Formulary
  Oral solution
Verapamil hydrochloride (Non-proprietary) On Formulary
  Solution for injection
Securon (Viatris UK Healthcare Ltd) Hospital Only
  Oral tablet
Verapamil hydrochloride (Non-proprietary)
  xipamide Off Formulary
  Oral tablet
Diurexan (Viatris UK Healthcare Ltd)
Cardiovascular system / Portal hypertension
  carvedilol
  Oral tablet
Carvedilol (Non-proprietary)
  propranolol hydrochloride On Formulary
PROPRANOLOL HYDROCHLORIDE

Phaechromocytoma (usually started 24 hours after Phenoxybenzamine)

Also used orally for cutaneous haemangioma where topical timolol not appropriate.

For use in the management of acute alcohol withdrawal-see 'Alcohol dependence https://www.formularycomplete.com/view/treatmentsummary/monograph/848264 

PROPRANOLOL for thyrotoxicosis

Symptomatic relief of thyrotoxicosis-

  Modified-release capsule
Bedranol SR (Almus Pharmaceuticals Ltd, Sandoz Ltd)
Propranolol

Whipps Cross: somatic manifestations of acute alcohol withdrawal-  see alcohol dependance for more information
 

Beta-Prograne (Accord-UK Ltd, Tillomed Laboratories Ltd)
Half Beta-Prograne (Accord-UK Ltd, Tillomed Laboratories Ltd)
  Oral solution
Propranolol hydrochloride (Non-proprietary) On Formulary
  Oral tablet
Propranolol hydrochloride (Non-proprietary)
Cardiovascular system / Pulmonary hypertension
  ambrisentan Off Formulary
AMBRISENTAN

HOSPITAL ONLY

  Oral tablet
Ambrisentan (Non-proprietary)
Volibris (GlaxoSmithKline UK Ltd)
  bosentan Off Formulary
BOSENTAN

HOSPITAL ONLY

  Oral tablet
Bosentan (Non-proprietary)
  epoprostenol Hospital Only
Nebulised Epoprostenol in Critical Care

Can be nebulised for ventilated patients with hypoxaemia in context acute respiratory distress syndrome and/or raised pulmonary vascular resistance within intensive care setting - refer to local guideline - note this is unlicensed use

Epoprostenol PVD

Indication Initial Dose Treatment Duration Peripheral Vascular Disease 2nanograms/kg/min increased by 1 nanogram/kg/min up to 10nanograms/kg/min or until limited by side effects. The average dose is 5 – 7 nanograms/kg/min.  Treatment is for 72 hours continuously. Raynaud’s Phenomenon 2nanograms/kg/min increased by 1 nanogram/kg/min up to 10nanograms/kg/min or until limited by side effects Treatment is for 12 hours daily and is usually repeated for 3 – 5 consecutive days

 

Intervals increased at increments of at least 15 minutes

 

Blocked catheters and lines - in renal dialysis

Blocked catheters and lines - note, this relates to those on renal dialysis - further details below in indications

  Powder for solution for infusion
Epoprostenol (Non-proprietary)
Veletri (Janssen-Cilag Ltd)
  Powder and solvent for solution for infusion
Flolan (GlaxoSmithKline UK Ltd)
Epoprostenol PVD

 

Indication Initial Dose Treatment Duration Peripheral Vascular Disease 2nanograms/kg/min increased by 1 nanogram/kg/min up to 10nanograms/kg/min or until limited by side effects. The average dose is 5 – 7 nanograms/kg/min.  Treatment is for 72 hours continuously. Raynaud’s Phenomenon 2nanograms/kg/min increased by 1 nanogram/kg/min up to 10nanograms/kg/min or until limited by side effects Treatment is for 12 hours daily and is usually repeated for 3 – 5 consecutive days.

Intervals increased at increments of at least15 minutes

  iloprost Hospital Only
ILOPROST

FOR HOSPITAL USE ONLY

  Solution for infusion
Iloprost (Non-proprietary)
  Nebuliser liquid
Iloprost (Non-proprietary)
Ventavis (Bayer Plc)
  macitentan Off Formulary
  Oral tablet
Opsumit (Janssen-Cilag Ltd)
  riociguat Off Formulary
  Oral tablet
Adempas (Merck Sharp & Dohme (UK) Ltd)
  selexipag Off Formulary
  Oral tablet
Uptravi (Janssen-Cilag Ltd)
  sildenafil Hospital Only
  Oral suspension
Sildenafil (Non-proprietary)
Revatio (Viatris UK Healthcare Ltd)
  Solution for injection
Revatio (Viatris UK Healthcare Ltd)
  Oral tablet
Sildenafil (Non-proprietary)
Granpidam (Accord-UK Ltd)
Revatio (Viatris UK Healthcare Ltd)
Viagra (Viatris UK Healthcare Ltd)
  tadalafil Off Formulary
  Oral tablet
Tadalafil (Non-proprietary)
Adcirca (Eli Lilly and Company Ltd)
Cialis (Eli Lilly and Company Ltd)
Talmanco (Viatris UK Healthcare Ltd)
  treprostinil
  Solution for infusion
Treprostinil (Non-proprietary)
Treposuvi (AOP Orphan Ltd)
Trepulmix (AOP Orphan Ltd)
Cardiovascular system / Hypertension associated with phaeochromocytoma
  phenoxybenzamine hydrochloride Hospital Only
PHENOXYBENZAMINE HYDROCHLORIDE

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY

Phaeochromocytoma (start propranolol 24hours after initiation of phenoxybenzamine)

IV infusion is used once daily for 3 days prior to surgery

 

NOTE - long term manufacturing issues - not currently available

  Oral capsule
Phenoxybenzamine hydrochloride (Non-proprietary)
  propranolol hydrochloride On Formulary
PROPRANOLOL HYDROCHLORIDE

Phaechromocytoma (usually started 24 hours after Phenoxybenzamine)

Also used orally for cutaneous haemangioma where topical timolol not appropriate.

For use in the management of acute alcohol withdrawal-see 'Alcohol dependence https://www.formularycomplete.com/view/treatmentsummary/monograph/848264 

PROPRANOLOL for thyrotoxicosis

Symptomatic relief of thyrotoxicosis-

  Modified-release capsule
Bedranol SR (Almus Pharmaceuticals Ltd, Sandoz Ltd)
Propranolol

Whipps Cross: somatic manifestations of acute alcohol withdrawal-  see alcohol dependance for more information
 

Beta-Prograne (Accord-UK Ltd, Tillomed Laboratories Ltd)
Half Beta-Prograne (Accord-UK Ltd, Tillomed Laboratories Ltd)
  Oral solution
Propranolol hydrochloride (Non-proprietary) On Formulary
  Oral tablet
Propranolol hydrochloride (Non-proprietary)
Cardiovascular system / Hypertensive crises
  hydralazine hydrochloride On Formulary
HYDRALAZINE HYDROCHLORIDE

IV FORMULATION IS FOR HOSPITAL USE ONLY

  Powder for solution for injection
Hydralazine hydrochloride (Non-proprietary) On Formulary
HYDRALAZINE HYDROCHLORIDE

IV FORMULATION IS FOR HOSPITAL USE ONLY

  Oral tablet
Hydralazine hydrochloride (Non-proprietary)
Apresoline (Advanz Pharma)
  labetalol hydrochloride On Formulary
LABETALOL HYDROCHLORIDE

First line for management of hypertension in pregnancy.

http://publications.nice.org.uk/hypertension-in-pregnancy-cg107

Please note: The injection is HOSPITAL ONLY.

  Solution for injection
Labetalol hydrochloride (Non-proprietary) On Formulary
Labetalol Hydrochloride

Please note: The injection is HOSPITAL ONLY.

  Oral tablet
Labetalol hydrochloride (Non-proprietary)
Trandate (RPH Pharmaceuticals AB)
  sodium nitroprusside Hospital Only
  Powder and solvent for solution for infusion
Sodium nitroprusside (Non-proprietary)
Cardiovascular system / Hypotension and shock
  Etilefrine On Formulary
Etilefrine for priapism

Etilefrine 25mg tablets available as named patient for priapism.
Doses of 25mg twice daily initially.

Etilefrine

Approved Indication at Barts Health
Secondary prevention of priapism in adult and paediatric patients with sickle cell disease (unlicensed)

Paediatric patients -                0.5mg/kg at night OR 0.25mg/kg bd (depending on when the onset of symptoms is more common, e.g.                                              night  only, or both during the day and night

Adults -                                      25mg at night (may increase to TWICE daily in resistant cases)

 
Continue for a total of 4 weeks, then stop/wean depending on recurrence 
Monitor blood pressure (follow up at 1 week and then monthly)

  angiotensin II
  Solution for infusion
Giapreza (PAION Deutschland GmbH)
  dobutamine Hospital Only
  Solution for infusion
Dobutamine (Non-proprietary) On Formulary
  dopamine hydrochloride Hospital Only
  Solution for infusion
Dopamine hydrochloride (Non-proprietary) On Formulary
  ephedrine hydrochloride Hospital Only
Inhaled Ephedrine (Primatene Mist)- Non-formulary

Inhaled Ephedrine is not recommended for the treatment of asthma.

Please contact the Pharmacy respiratory team for advice if ever prescribed for asthma.

Please contact Emergency Medicine Lead Pharmacist for advice if prescribed for patient in ED.

  Solution for injection
Ephedrine hydrochloride (Non-proprietary) On Formulary
  Oral tablet
Ephedrine hydrochloride (Non-proprietary)
  metaraminol Hospital Only
Metaraminol 2.5mg/5ml ampoules shortage

This shortage will primarily affect the Newham University Hospital and Whipps Cross University Hospital sites and is likely to last until the end of December 2020.

 

See attached memo

Metaraminol - ICU recovery protocol

see attached

  Solution for injection
Metaraminol (Non-proprietary) On Formulary
Metaraminol - ICU recovery protocol

see attached

  midodrine hydrochloride On Formulary
Midodrine for orthostatic hypotension or vasovagal syncope

 Midodrine

  Oral tablet
Midodrine hydrochloride (Non-proprietary)
Bramox (Brancaster Pharma Ltd)
  noradrenaline/norepinephrine Hospital Only
Noradrenaline IV Monograph (Adult Critical Care Only)

For use in Adult Critical Care areas only.

  Solution for infusion
Noradrenaline/norepinephrine (Non-proprietary) On Formulary
Sinora (Sandoz Ltd)
  phenylephrine hydrochloride On Formulary
  Solution for injection
Phenylephrine hydrochloride (Non-proprietary) On Formulary
  Eye drops
Phenylephrine hydrochloride (Non-proprietary)
  sodium nitroprusside Hospital Only
  Powder and solvent for solution for infusion
Sodium nitroprusside (Non-proprietary)
Cardiovascular system / Vascular disease
  cilostazol Off Formulary NICE TA223
  Oral tablet
Cilostazol (Non-proprietary)
  iloprost
  Solution for infusion
Iloprost (Non-proprietary)
  Nebuliser liquid
Iloprost (Non-proprietary)
Ventavis (Bayer Plc)
  inositol nicotinate Off Formulary NICE TA223
  Oral capsule
Inositol nicotinate (Non-proprietary)
  naftidrofuryl oxalate On Formulary NICE TA223
NAFTIDROFURYL OXALATE

First-line option for peripheral arterial disease.

Naftidrofuryl technology appraisal
 

https://www.nice.org.uk/guidance/ta223

  Oral capsule
Naftidrofuryl oxalate (Non-proprietary)
Praxilene (Merck Serono Ltd)
  nifedipine On Formulary
Leiomyoma pain

Nidfedipine 10-20mg daily or twice daily is used in dermatology for pain resulting from leiomyoma

  Modified-release tablet
Adalat LA (Bayer Plc) On Formulary
Leiomyoma pain

Nidfedipine 10-20mg daily or twice daily is used in dermatology for pain resulting from leiomyoma

Adanif XL (Advanz Pharma)
Adipine MR (Chiesi Ltd)
Adipine XL (Chiesi Ltd)
Dexipress MR (Dexcel-Pharma Ltd)
Fortipine LA (Advanz Pharma)
Neozipine XL (Kent Pharma (UK) Ltd)
Nifedipress MR (Dexcel-Pharma Ltd)
Tensipine MR (Genus Pharmaceuticals Ltd)
Valni Retard (Tillomed Laboratories Ltd)
  Modified-release capsule
Coracten SR (Teofarma S.r.l.)
Coracten XL (Teofarma S.r.l.)
  Oral drops
Nifedipine (Non-proprietary)
  Oral capsule
Nifedipine (Non-proprietary)
  oxerutins Off Formulary
  Oral capsule
Paroven (Thornton & Ross Ltd)
  pentoxifylline On Formulary NICE TA223
  Modified-release tablet
Trental (Neuraxpharm UK Ltd)
  prazosin Off Formulary
  Oral tablet
Prazosin (Non-proprietary)
Hypovase (Pfizer Ltd)
Cardiovascular system / Vein malformations
  lauromacrogol 400
  Solution for injection
Lauromacrogol 400 (Non-proprietary)
Aethoxysklerol (Kora Healthcare)
  sodium tetradecyl sulfate On Formulary
SODIUM TETRADECYL SULFATE

Sclerotherapy of varicose veins.

Caution: Extravasation may arise and cause necrosis of tissues.

  Solution for injection
Fibro-Vein (STD Pharmaceutical Products Ltd) On Formulary
Cardiovascular system / Cardiomyopathy
  mavacamten Hospital Only NICE TA913
NICE TA 913 - December 2023 - Mavacamten for treating symptomatic obstructive hypertrophic cardiomyopathy

Mavacamten approved at NEL FPG for treating symptomatic obstructive hypertrophic cardiomyopathy in line with NICE TA

 

**Patient must have explicit counselling with respect to patient specific interactions.

 

Hospital Only

 

 

 

 

 

 

 

 

  Oral capsule
Camzyos (Bristol-Myers Squibb Pharmaceuticals Ltd)
Cardiovascular system / Cardiac diagnostic procedures and surgeries
  Custodial® HTK Solution Hospital Only
  Perflutren (Luminity®) Hospital Only
  dobutamine Hospital Only
  Solution for infusion
Dobutamine (Non-proprietary) On Formulary
Cardiovascular system / Blocked catheters and lines
  epoprostenol Hospital Only
Nebulised Epoprostenol in Critical Care

Can be nebulised for ventilated patients with hypoxaemia in context acute respiratory distress syndrome and/or raised pulmonary vascular resistance within intensive care setting - refer to local guideline - note this is unlicensed use

Blocked catheters and lines - in renal dialysis

Blocked catheters and lines - note, this relates to those on renal dialysis - further details below in indications

  Powder for solution for infusion
Epoprostenol (Non-proprietary)
Veletri (Janssen-Cilag Ltd)
  Powder and solvent for solution for infusion
Flolan (GlaxoSmithKline UK Ltd)
  heparin (unfractionated) On Formulary
Unfractionated Heparin (UFH): Monitoring in Adult Patients

 See below

  Solution for injection
Heparin (unfractionated) (Non-proprietary)
Heparin dose and rate adjustment according to APTT

At legacy BLT: IV infusion: Draw up 40ml of 1000units in 1ml heparin into a syringe (40,000units in 40ml).  Administer by continuous infusion according to the patient’s weight, at the rate as stated below:
Weight Rate(2) - mls per hour
of 1000units in 1ml concentration Greater than 90kg 1.7 81-90kg 1.6 71-80kg 1.4 61-70kg 1.2 51-60kg 1.0 41-50kg 0.8

 

Heparin dose and rate adjustment according to APTT

At legacy BLT: IV infusion: Draw up 40ml of 1000units in 1ml heparin into a syringe (40,000units in 40ml).  Administer by continuous infusion according to the patient’s weight, at the rate as stated below:
Weight Rate(2) - mls per hour
of 1000units in 1ml concentration Greater than 90kg 1.7 81-90kg 1.6 71-80kg 1.4 61-70kg 1.2 51-60kg 1.0 41-50kg 0.8

 

Guidelines for the Diagnosis, Investigation and Management of Heparin-Induced Thrombocytopenia (HIT) Guidelines for the Diagnosis, Investigation and Management of Heparin-Induced Thrombocytopenia (HIT)

HIT Guidelines 2016

  Infusion
Heparin (unfractionated) (Non-proprietary)
Heparin dose and rate adjustment according to APTT

At legacy BLT: IV infusion: Draw up 40ml of 1000units in 1ml heparin into a syringe (40,000units in 40ml).  Administer by continuous infusion according to the patient’s weight, at the rate as stated below:

Weight Rate(2) - mls per hour
of 1000units in 1ml concentration Greater than 90kg 1.7 81-90kg 1.6 71-80kg 1.4 61-70kg 1.2 51-60kg 1.0 41-50kg 0.8

  Form unstated
Heparin (unfractionated) (Non-proprietary)
  urokinase On Formulary
UROKINASE

Unblocking catheters:

An injection of 5 000 - 25 000 units per lumen can be given and line clamped for one hour before aspirating content (the duration can be extended to overnight in severe blockages)

Alternatively an infusion of 250 000 units in 100-250MLs of sodium chloride 0.9% can be given over 90 -180 minutes.

  Powder for solution for injection
Syner-KINASE (Syner-Med (Pharmaceutical Products) Ltd)
Cardiovascular system / Thromboembolism
  acenocoumarol On Formulary
  Oral tablet
Sinthrome (Norgine Pharmaceuticals Ltd)
  alteplase Hospital Only NICE TA264
PE guidelines

See below for link to guidelines

ALTEPLASE

For treatment of stroke and PE

Alteplase for treating acute ischaemic stroke guidelines

http://www.nice.org.uk/guidance/TA264

Thrombolysis with Alteplase

.

  Powder and solvent for solution for injection
Actilyse (Boehringer Ingelheim Ltd) Hospital Only
  Powder and solvent for solution for infusion
Actilyse (Boehringer Ingelheim Ltd) Hospital Only
  andexanet alfa Hospital Only NICE TA697
Reversing anticoagulation from apixaban or rivaroxaban

Approved by DTC as per NICE TA 697

  Powder for solution for infusion
Ondexxya (AstraZeneca UK Ltd)
  apixaban On Formulary NICE TA245
NICE TA275
NICE TA341
Anticoagulation intranet page

Scroll down for links to documents on the fileshare

Selection of NOAC guidance

see attached

Apixaban: Primary Care Prescriber Information

Apixaban: Primary Care Prescriber Information

APIXABAN (other uses)

  • Prevention of stroke and embolism in adult patients with non-valvular AF
  • Prophylaxis of venous thromboembolism following total hip replacement surgery
  • Prophylaxis of venous thromboembolism following total knee replacement surgery

Transfer of Care document - Treatment of PE in COVID patients

see attached

May-2024, Apixaban- Following gynecology oncology surgery (off-label)

Apixaban approved at NEL FPG for prophylaxis of venous thromboembolism (VTE) following gynaecology oncology surgery at Barts Health NHS Trust.

 

Formulary Status: Hospital Only

GUIDELINES/COUNSELLING CHECKLIST

See below for link to guidelines and counselling checklist:

  Oral tablet
Apixaban (Non-proprietary)
Eliquis (Bristol-Myers Squibb Pharmaceuticals Ltd)
  argatroban monohydrate Hospital Only
Heparin Induced Thrombocytopenia (HIT)

https://weshare.bartshealth.nhs.uk/haematology-immunology?media_item=16727&media_type=10#file-viewer

  Solution for infusion
Argatroban monohydrate (Non-proprietary)
Exembol (Mitsubishi Tanabe Pharma Europe Ltd)
  aspirin On Formulary
Aspirin

Should not routinely used for primary prevention of cardiovascular disease.

Enteric coated aspirin should not be used as it has a poor cost:benefit ratio. There is no convincing evidence that it reduces gastrointestinal bleeding (Drug Ther Bulletin, Jan 1997, p.7-8) and it has a lower bioavailability vs dispersable.

Gastroprotection with lansoprazole is advised.

 

Aspirin has multiple indications, follow the links below for more information


Unstable angina and NSTEMI guidelines

http://www.nice.org.uk/guidance/CG94

Stroke guidelines

http://www.nice.org.uk/Guidance/CG68

STEMI guidelines

http://www.nice.org.uk/guidance/CG167

AF guidelines

http://www.nice.org.uk/guidance/cg180

Hypertension in pregnancy guidelines

http://www.nice.org.uk/guidance/CG107

  Dispersible tablet
Aspirin (Non-proprietary)
Disprin (Reckitt Benckiser Healthcare (UK) Ltd)
  Gastro-resistant tablet
Aspirin (Non-proprietary)
Nu-Seals (Alliance Pharmaceuticals Ltd)
  Suppository
Aspirin (Non-proprietary)
  Oral tablet
Aspirin (Non-proprietary)
  bemiparin sodium
  bivalirudin Hospital Only
Heparin Induced Thrombocytopenia (HIT)

https://weshare.bartshealth.nhs.uk/haematology-immunology?media_item=16727&media_type=10#file-viewer

  Powder for solution for infusion
Bivalirudin (Non-proprietary)
  clopidogrel On Formulary NICE TA210
Antiplatelet and eptifibatide advice in Acute Coronary Syndromes

CLOPIDOGREL

First-line monotherapy after acute phase for ischaemic stroke in absence of atrial fibrillation.  Assess bleeding risk for co-prescription of PPIs. 
NB: Omeprazole should not be used with clopidogrel.

For secondary prevention of cardiosvascular disease if aspirin contraindicated or not tolerated.

Can be used where aspirin contraindicated for any indication.

Indicate course length on communications if combined with other antithrombotic therapy, i.e. for 12 months post acute MI as dual antiplatelet therapy (with aspirin).

Commonly loaded with 600mg prior to coronary artery stenting (with or with out ACS) - NOTE this is an unlicensed dose 

Consider lansoprazole or H2 antagonists (ranitidine) as gastroprotection with clopidogrel treatment.

Clopidogrel and Dipyridamole M/R use in prophylaxis technology appraisal

http://www.nice.org.uk/guidance/TA210

  Oral tablet
Clopidogrel (Non-proprietary)
Plavix (Sanofi)
  dabigatran etexilate On Formulary NICE TA157
NICE TA249
NICE TA327
GUIDELINES/COUNSELLING CHECKLIST

See below for links to guidelines and counselling checklist

Dabigatran reversal agent: Idarucizumab

Is a specific reversal agent for dabigatran - used for when rapid reversal of anticoagulation is required

  • For emergency surgery / urgent procedures
  • In life-threatening or uncontrolled bleeding

The dose is the same for all patients: 5g (2 X 2.5g) administered intravenously as two consecutive infusions of 2.5g/50mL each time. 

Primary Care Prescriber Information

Dabigatran: Primary Care Prescriber Information

DABIGATRAN ETEXILATE (other uses)

  • Prevention of stroke and embolism in adult patients with non-valvular AF
  • Prophylaxis of venous thromboembolism following total hip replacement surgery
  • Prophylaxis of venous thromboembolism following total knee replacement surgery

Anticoagulation Contacts

Scroll down for links to documents on the fileshare

  Oral capsule
Dabigatran etexilate (Non-proprietary)
Pradaxa (Boehringer Ingelheim Ltd)
  dalteparin sodium Off Formulary
  Solution for injection
Fragmin (Pfizer Ltd)
  danaparoid sodium On Formulary
  Solution for injection
Danaparoid sodium (Non-proprietary) On Formulary
  dipyridamole On Formulary NICE TA210
DIPYRIDAMOLE

 
Second line for ischaemic stroke in combination with aspirin: only if clopidogrel is contraindicated or not tolerated.
Use monotherapy only if aspirin and clopidogrel are contraindicated or not tolerated.
Use MR preparation.

Clopidogrel and Dipyridamole M/R use in prophylaxis technology appraisal

http://www.nice.org.uk/guidance/TA210

  Modified-release capsule
Dipyridamole (Non-proprietary)
Attia (Dr Reddy's Laboratories (UK) Ltd)
  Oral suspension
Dipyridamole (Non-proprietary)
  Oral tablet
Dipyridamole (Non-proprietary)
  edoxaban On Formulary NICE TA354
NICE TA355
GUIDELINES/COUNSELLING CHECKLIST

See links below for guidelines and counselling checklist

Edoxaban: Primary Care Prescriber Information

Edoxaban: Primary Care Prescriber Information

Edoxaban (other uses)

  • Prevention of stroke and embolism in adult patients with non-valvular AF

Anticoagulation intranet page

Scroll down for links to documents on the fileshare

  Oral tablet
Lixiana (Daiichi Sankyo UK Ltd)
  enoxaparin sodium On Formulary
LMWH Shared Care Guideline

LMWH Shared Care Guideline

GUIDELINES

See below for links to guidelines

Transfer of Care document - Treatment of PE in COVID patients

see attached

Peri-operative management

Peri-operative management

Anticoagulation Contacts

Scroll down for links to documents on the fileshare

  Solution for injection
Arovi (ROVI Biotech Ltd)
Clexane (Sanofi) On Formulary
Anticoagulation intranet page

Scroll down for links to documents on the fileshare

Enoxaparin shared care guidelines

Inhixa (Techdow Pharma England Ltd)
Ledraxen (Tetris Pharma Ltd)
  fondaparinux sodium On Formulary
Fondaparinux in acute coronary syndrome

Fondaparinux is now the trusts formulary choice of anticoagulant in NSTEMI-ACS.

Dose 2.5mg ONCE DAILY

Mode of administration Subcutaneous

If undergoing PCI Preferably undergo PCI 4 - 24 hours after receiving the last fondaparinux dose and use UFH as an adjunct as per current practice. 

USE ALTERNATIVE anticoagulant if patient has a pre existing medical condition requiring anticoagulation - i.e. AF, DVT, mechanical valve etc - use enoxaparin 1mg/kg twice daily (adjusted for renal function).

To stop post angioplasty unless clinically indicated

Platelet monitoring Not required

Contra-indication CrCl <20mls/mins if known, and use UFH

FONDAPARINUX SODIUM

For acute coronary syndrome

Heparin Induced Thrombocytopenia (HIT)

https://weshare.bartshealth.nhs.uk/haematology-immunology?media_item=16727&media_type=10#file-viewer

  Solution for injection
Fondaparinux sodium (Non-proprietary) On Formulary
Fondaparinux in acute coronary syndrome

Fondaparinux is now the trusts formulary choice of anticoagulant in NSTEMI-ACS.

Dose 2.5mg ONCE DAILY

Mode of administration Subcutaneous

If undergoing PCI Preferably undergo PCI 4 - 24 hours after receiving the

last fondaparinux dose and use UFH as an adjunct as

per current practice.

To stop post angioplasty unless clinically indicated

Platelet monitoring Not required

Contra-indication CrCl <20mls/mins if known, and use UFH

Arixtra (Viatris UK Healthcare Ltd) On Formulary
Fondaparinux in acute coronary syndrome

Fondaparinux is now the trusts formulary choice of anticoagulant in NSTEMI-ACS.

Dose 2.5mg ONCE DAILY

Mode of administration Subcutaneous

If undergoing PCI Preferably undergo PCI 4 - 24 hours after receiving the

last fondaparinux dose and use UFH as an adjunct as

per current practice.

To stop post angioplasty unless clinically indicated

Platelet monitoring Not required

Contra-indication CrCl <20mls/mins if known, and use UFH

  heparin (unfractionated) On Formulary
Unfractionated Heparin (UFH): Monitoring in Adult Patients

 See below

  Solution for injection
Heparin (unfractionated) (Non-proprietary)
Heparin dose and rate adjustment according to APTT

At legacy BLT: IV infusion: Draw up 40ml of 1000units in 1ml heparin into a syringe (40,000units in 40ml).  Administer by continuous infusion according to the patient’s weight, at the rate as stated below:
Weight Rate(2) - mls per hour
of 1000units in 1ml concentration Greater than 90kg 1.7 81-90kg 1.6 71-80kg 1.4 61-70kg 1.2 51-60kg 1.0 41-50kg 0.8

 

Heparin dose and rate adjustment according to APTT

At legacy BLT: IV infusion: Draw up 40ml of 1000units in 1ml heparin into a syringe (40,000units in 40ml).  Administer by continuous infusion according to the patient’s weight, at the rate as stated below:
Weight Rate(2) - mls per hour
of 1000units in 1ml concentration Greater than 90kg 1.7 81-90kg 1.6 71-80kg 1.4 61-70kg 1.2 51-60kg 1.0 41-50kg 0.8

 

Guidelines for the Diagnosis, Investigation and Management of Heparin-Induced Thrombocytopenia (HIT) Guidelines for the Diagnosis, Investigation and Management of Heparin-Induced Thrombocytopenia (HIT)

HIT Guidelines 2016

  Infusion
Heparin (unfractionated) (Non-proprietary)
Heparin dose and rate adjustment according to APTT

At legacy BLT: IV infusion: Draw up 40ml of 1000units in 1ml heparin into a syringe (40,000units in 40ml).  Administer by continuous infusion according to the patient’s weight, at the rate as stated below:

Weight Rate(2) - mls per hour
of 1000units in 1ml concentration Greater than 90kg 1.7 81-90kg 1.6 71-80kg 1.4 61-70kg 1.2 51-60kg 1.0 41-50kg 0.8

  Form unstated
Heparin (unfractionated) (Non-proprietary)
  idarucizumab Hospital Only
Idarucizumab

Is a specific reversal agent for dabigatran - used for when rapid reversal of anticoagulation is required

  • For emergency surgery / urgent procedures
  • In life-threatening or uncontrolled bleeding

The dose is the same for all patients: 5g (2 X 2.5g) administered intravenously as two consecutive infusions of 2.5g/50mL each time. 

Stock control of Idarucizumab across Barts Health NHS Trust

see attached

Guidelines for management of bleeding with NOACs - 2016

see attached

  Solution for infusion
Praxbind (Boehringer Ingelheim Ltd)
  phenindione Off Formulary
  Oral tablet
Phenindione (Non-proprietary)
  prasugrel On Formulary NICE TA317
PRASUGREL

Specialist initiation for acute coronary syndrome - third line after other P2Y12 inhibitors not tolerated or unable to be used due to interactions.


To be used in combination with aspirin.

Approved for neurovascular stenting for patients who are resistant to clopidogrel

Approved September DTC 2021

  Oral tablet
Prasugrel (Non-proprietary)
Efient (Vygoris Ltd)
  rivaroxaban On Formulary NICE TA170
NICE TA256
NICE TA261
NICE TA287
NICE TA335
NICE TA607
GUIDELINES/COUNSELLING CHECKLIST

See below for links to guidelines and counselling checklist

Rivaroxaban: Primary Care Prescriber Information

Rivaroxaban: Primary Care Prescriber Information

Heparin Induced Thrombocytopenia (HIT) approved October 2020 DTC

On formulary for Heparin Induced Thrombocytopenia (HIT) - Approved in October 2020 DTC

 

Superficial Vein Thrombosis

Approved as Hospital Only for Superficial Vein Thrombosis in July 2021 Drugs and Therapeutics Committee.

RIVAROXABAN (other uses)

  • Prevention of stroke and embolism in adult patients with non-valvular AF
  • Prophylaxis of venous thromboembolism following total hip replacement surgery
  • Prophylaxis of venous thromboembolism following total knee replacement surgery

Venous Thrombo-Embolism (VTE) and prevention of VTE recurrence in paediatric patients (September-2021)

Approved by DTC as Hospital Only for Superficial Vein Thrombosis in paediatric patients 

Superficial Vein Thrombosis (SVT) (July 2021)

Rivaroxaban 10mg tablets Approved by the DTC as Hospital Only for treatment of Superficial Vein Thrombosis in adult patients.

Anticoagulation Contacts

Scroll down for links to documents on the fileshare

  Oral tablet
Rivaroxaban (Non-proprietary)
Xarelto (Bayer Plc)
  streptokinase Hospital Only
Streptokinase

This is a second line agent - please consider use of first line agent such as tenectoplase or alteplase depending on the indication - see seperate monograph for more information.

  Powder for solution for infusion
Streptokinase (Non-proprietary)
  ticagrelor NICE TA236
NICE TA420
  Orodispersible tablet
Brilique (AstraZeneca UK Ltd)
  Oral tablet
Brilique (AstraZeneca UK Ltd)
  tinzaparin sodium On Formulary
LMWH Shared Care Guideline

LMWH Shared Care Guideline

GUIDELINES

See below for links to guidelines

MEMO regarding Tinzaparin Guidelines for Obstetric Patients


Transfer of Care document - Treatment of PE in COVID patients

see attached document

Anticoagulation Contacts

Scroll down for links to documents on the fileshare

Peri-Operative Management of Oral Anticoagulation

Peri-Operative Management of Oral Anticoagulation

  Solution for injection
Tinzaparin sodium (Non-proprietary)
  urokinase On Formulary
UROKINASE

Unblocking catheters:

An injection of 5 000 - 25 000 units per lumen can be given and line clamped for one hour before aspirating content (the duration can be extended to overnight in severe blockages)

Alternatively an infusion of 250 000 units in 100-250MLs of sodium chloride 0.9% can be given over 90 -180 minutes.

  Powder for solution for injection
Syner-KINASE (Syner-Med (Pharmaceutical Products) Ltd)
  warfarin sodium On Formulary
GUIDELINES/COUNSELLING CHECKLIST

See below for links to guidelines/counselling checklist

Warfarin Management

Warfarin management

Warfarin

Liquid not stocked.
0.5mg tablets not stocked.

Anticoagulation Contacts

Scroll down for links to documents on the fileshare

  Oral suspension
Warfarin sodium (Non-proprietary) On Formulary
Anticoagulation intranet page

Scroll down for links to documents on the fileshare

Warfarin initiation

see attached

Warfarin

Liquid not stocked.
0.5mg tablets not stocked.

  Oral tablet
Warfarin sodium (Non-proprietary)
Cardiovascular system / Oedema
  amiloride hydrochloride On Formulary
AMILORIDE HYDROCHLORIDE

 Usually in conjunction with furosemide (co-amilofruse) to maintain K+ while on diuretic treament.
 

  Oral solution
Amiloride hydrochloride (Non-proprietary) On Formulary
  Oral tablet
Amiloride hydrochloride (Non-proprietary)
  amiloride with bumetanide Off Formulary
  Oral tablet
Amiloride with bumetanide (Non-proprietary)
  bumetanide On Formulary
BUMETANIDE

.

  Oral solution
Bumetanide (Non-proprietary) On Formulary
  Oral tablet
Bumetanide (Non-proprietary)
  chlortalidone Off Formulary
  Oral tablet
Chlortalidone (Non-proprietary)
Hylaton (Morningside Healthcare Ltd)
  co-amilofruse On Formulary
  Oral tablet
Co-amilofruse (Non-proprietary)
Frumil (Sanofi)
  diamorphine hydrochloride
National supply shortage of Diamorphine 5mg and 10mg Injections

The trust has received notification from the Department of Health & Social Care regarding a national supply shortage of Diamorphine 5mg and 10mg Injections. This shortage is anticipated to last until summer 2020. Please see the memo attached for further information for this drug shortage.

  Powder for solution for injection
Diamorphine hydrochloride (Non-proprietary)
National supply shortage of Diamorphine 5mg and 10mg Injections

The trust has received notification from the Department of Health & Social Care regarding a national supply shortage of Diamorphine 5mg and 10mg Injections. This shortage is anticipated to last until summer 2020. Please see the memo attached for further information for this drug shortage.

  furosemide On Formulary
FUROSEMIDE

First line for treating fluid accumulation associtated with heart failure.


https://www.nice.org.uk/guidance/ng106

 

  Oral solution
Furosemide (Non-proprietary) On Formulary
Agreed standard strength for paediatrics

Furosemide

40mg/5ml should be used in adults only

50mg/5ml should be used for all paediatric doses 1mg or greater

20mg/5ml is reserved for Neonatal doses <1mg

Frusol (Rosemont Pharmaceuticals Ltd)
  Solution for injection
Furosemide (Non-proprietary) On Formulary
  Oral tablet
Furosemide (Non-proprietary)
  furosemide with triamterene Off Formulary
  mannitol Hospital Only NICE TA266
Osmohale Inhalation Powde (Mannitol) challenge to diagnose bronchial hyper-responsiveness (February 2023)

Mannitol was approved at NEL FPG as a third line option to histamine for aiding the diagnosis of bronchial hyper-responsiveness in adults where other diagnostics had been inconclusive, as an indirect challenge test.  

  Infusion
Mannitol (Non-proprietary)
  Inhalation powder
Mannitol (Non-proprietary)
Bronchitol (Chiesi Ltd)
  metolazone On Formulary
METOLAZONE

If metolazone available:
Used in renal patients for the treatment of oedema

Switching to the UK licensed preparation of Xaqua®(metolazone) 5mg tablets, May 2023

The Trust switched to the UK licensed preparation of Xaqua®(metolazone) 5mg tablets for all areas across the Trust. 

Metolazone caution with loop diuretics

Metolazone is a potent diuretic and when used with loop diuretics can cause a dramatic diuresis and disturbance to fluid balance and electrolytes due to sequential blockade of the nephron. Patients must be closely monitored and this combination should only be initiated by specialists with experience of using this combination e.g. cardiology or renal teams.  Any patient discharged on the combination should have an outpatient follow-up appointment within two weeks.

Dosage and adminstration when used in combination with loop diuretics:
Starting dose: 2.5 mg on alternate days or daily
Titrate by 2.5mg dose increments according to response
Maximum dose: 7.5mg once daily

NOTE: Unlicensed

  Oral tablet
Metolazone (Non-proprietary)
Xaqua (Renascience Pharma Ltd)
  spironolactone with furosemide Off Formulary
  torasemide Off Formulary
  Oral tablet
Torasemide (Non-proprietary)
Torem (Viatris UK Healthcare Ltd)
  triamterene Off Formulary
  triamterene with chlortalidone Off Formulary
  Oral tablet
Triamterene with chlortalidone (Non-proprietary)
  xipamide Off Formulary
  Oral tablet
Diurexan (Viatris UK Healthcare Ltd)
Cardiovascular system / Ascites
  chlortalidone Off Formulary
  Oral tablet
Chlortalidone (Non-proprietary)
Hylaton (Morningside Healthcare Ltd)
  co-amilozide Off Formulary
  Oral tablet
Co-amilozide (Non-proprietary)
  spironolactone On Formulary
SPIRONOLACTONE

Hypertension: Consider further diuretic therapy with low-dose spironolactone (25 mg once daily)  if the blood potassium level is 4.5 mmol/l or lower. Use particular caution in people with a reduced estimated glomerular filtration rate because they have an increased risk of hyperkalaemia. NICE CG 127

Heart failure: with preserved ejection fraction as determined by specialist.  NICE CG 108

Ascites, nephrotic syndrome, Conn's syndrome (300mg-600mg per day)

Doses above 100mg daily may be associated with impotence in males.

  Oral solution
Spironolactone (Non-proprietary)
  Oral tablet
Spironolactone (Non-proprietary)
Aldactone (Pfizer Ltd)
Cardiovascular system / Hyperlipidaemia
  acipimox Off Formulary
  Oral capsule
Olbetam (Pfizer Ltd)
  alirocumab Hospital Only NICE TA393
ALIROCUMAB

Approved for use in accordance with NICE TA393 .ONLY TO BE PRESCRIBED AT BARTS HEART CENTRE UNDER SPECIALIST ADVICE OF LIPID CLINIC.

  Solution for injection
Praluent (Sanofi)
  atorvastatin On Formulary
ATORVASTATIN

First line for secondary and primary prevention - dosing as per NICE guidance.


First-line for familial hypercholesterolaemia.

Secondary prevention of MI guidelines

http://www.nice.org.uk/guidance/cg172

Lipid modification guidelines
 
https://www.nice.org.uk/guidance/cg181
 
Identification and management of familial hypercholesterolaemia

http://www.nice.org.uk/Guidance/CG71
 

  Chewable tablet
Lipitor (Viatris UK Healthcare Ltd)
  Oral suspension
Atorvastatin (Non-proprietary)
  Oral tablet
Atorvastatin (Non-proprietary)
Lipitor (Viatris UK Healthcare Ltd)
  bempedoic acid On Formulary NICE TA694
  Oral tablet
Nilemdo (Daiichi Sankyo UK Ltd)
  bempedoic acid with ezetimibe On Formulary NICE TA694
  Oral tablet
Nustendi (Daiichi Sankyo UK Ltd)
  bezafibrate On Formulary
  Modified-release tablet
Bezalip Mono (Teva UK Ltd)
Lipozate (Noumed Life Sciences Ltd)
  Oral tablet
Bezafibrate (Non-proprietary)
Bezalip (Teva UK Ltd)
  ciprofibrate Off Formulary
  Oral tablet
Ciprofibrate (Non-proprietary)
  colesevelam hydrochloride On Formulary
COLESEVELAM HYDROCHLORIDE

Second line bile acid sequestrant if colestyramine not tolerated.

  Oral tablet
Colesevelam hydrochloride (Non-proprietary)
Cholestagel (Neon Healthcare Ltd)
  colestipol hydrochloride
  Oral tablet
Colestipol hydrochloride (Non-proprietary)
  colestyramine On Formulary
COLESTYRAMINE

First line option as a bile acid sequestrant.

Lipid modification guidelines
 
https://www.nice.org.uk/guidance/cg181

  Powder for oral suspension
Colestyramine (Non-proprietary)
Questran (Neon Healthcare Ltd)
Questran Light (Neon Healthcare Ltd)
  evinacumab
  Solution for infusion
Evkeeza (Ultragenyx UK Ltd)
  evolocumab Hospital Only NICE TA394
Evolocumab

Approved for use in accordance with NICE TA394. ONLY TO BE PRESCRIBED AT BARTS HEART CENTRE UNDER SPECIALIST ADVICE OF LIPID CLINIC.

  Solution for injection
Repatha SureClick (Amgen Ltd) On Formulary
  ezetimibe On Formulary NICE TA385
  Oral tablet
Ezetimibe (Non-proprietary)
Ezetrol (Organon Pharma (UK) Ltd)
  fenofibrate On Formulary
FENOFIBRATE

For raised triglycerides.

Fenofibrate has similar efficacy to bezafibrate in the reduction of triglycerides.
Fenofibrate is however more efficacious in terms of lowering LDL reduction.

Lipid modification guidelines


https://www.nice.org.uk/guidance/CG181

  Oral tablet
Fenofibrate (Non-proprietary)
Supralip (Viatris UK Healthcare Ltd)
  Oral capsule
Fenofibrate (Non-proprietary)
Lipantil Micro (Viatris UK Healthcare Ltd)
  fluvastatin Off Formulary
  Modified-release tablet
Fluvastatin (Non-proprietary)
  Oral capsule
Fluvastatin (Non-proprietary)
  gemfibrozil On Formulary
  Oral tablet
Gemfibrozil (Non-proprietary)
Lopid (Pfizer Ltd)
  Oral capsule
Lopid (Pfizer Ltd)
  icosapent ethyl On Formulary NICE TA805
  Oral capsule
Vazkepa (Amarin Pharmaceuticals Ireland Ltd)
  inclisiran On Formulary NICE TA733
Primary hypercholesterolaemia or mixed dyslipidaemia

Hospital prescribing via NHSE reimbursement- reviewed April 2022 DTC. 

  Solution for injection
Leqvio (Novartis Pharmaceuticals UK Ltd)
  lomitapide Off Formulary
  Oral capsule
Lojuxta (Chiesi Ltd)
  nicotinic acid Off Formulary
  Oral capsule
Nicotinic acid (Non-proprietary)
  omega-3-acid ethyl esters On Formulary
  Oral capsule
Omega-3-acid ethyl esters (Non-proprietary)
A1 Omega (TriOn Pharma Ltd)
AceOmeg (Essential-Healthcare Ltd)
Teromeg (Advanz Pharma)
  pravastatin sodium On Formulary
  Oral tablet
Pravastatin sodium (Non-proprietary)
  rosuvastatin On Formulary
  Oral tablet
Rosuvastatin (Non-proprietary)
Crestor (AstraZeneca UK Ltd)
  Oral capsule
Rosuvastatin (Non-proprietary)
  simvastatin On Formulary
Simvastatin

Please note: Simvastatin 80mg are non-formulary.

  Oral suspension
Simvastatin (Non-proprietary) On Formulary
SIMVASTATIN

First line statin for reduction of total cholesterol.

See note below for combination with calcium channel blockers or bezafibrate.

http://publications.nice.org.uk/lipid-modification-cg67

NICE CG 71 Statins currently being updated.

Secondary prevention of MI guidelines

http://www.nice.org.uk/guidance/cg172

Statins for the prevention of cardiac events technology appraisal

http://www.nice.org.uk/guidance/TA094

Lipid modification guidelines

http://www.nice.org.uk/Guidance/CG67

Identification and management of familial hypercholesterolaemia

http://www.nice.org.uk/Guidance/CG71

Simvastatin bulletin

see attached

  Oral tablet
Simvastatin (Non-proprietary)
Zocor (Organon Pharma (UK) Ltd)
  simvastatin with ezetimibe Off Formulary
  Oral tablet
Simvastatin with ezetimibe (Non-proprietary)
Inegy (Organon Pharma (UK) Ltd)
  volanesorsen NICE HST13
  Solution for injection
Waylivra (Swedish Orphan Biovitrum Ltd)
Cardiovascular system / Bleeding disorders
  emicizumab Hospital Only
EMICIZUMAB

Contact Haemophilia Department at Royal London Hospital for supply

  Solution for injection
Hemlibra (Roche Products Ltd)
  tranexamic acid On Formulary
  Solution for injection
Tranexamic acid (Non-proprietary) Hospital Only
Guidelines for management of bleeding with NOACs - 2016

see attached

Cyklokapron (Pfizer Ltd) On Formulary
Guidelines for management of bleeding with NOACs - 2016

see attached

  Oral tablet
Tranexamic acid (Non-proprietary)
Cyklokapron (Viatris UK Healthcare Ltd)
Cardiovascular system / Coagulation factor deficiencies
  dried prothrombin complex Hospital Only
Octaplex Guidelines

Guidelines for management of bleeding with NOACs - 2016

Availability of haemostatic agents across Barts Health sites

https://weshare.bartshealth.nhs.uk/download.cfm?doc=docm93jijm4n12106&ver=33132

  Powder and solvent for solution for injection
Beriplex P/N (CSL Behring UK Ltd)
  Powder and solvent for solution for infusion
Octaplex (Octapharma Ltd)
  factor IX [Specialist drug] Hospital Only
FACTOR IX FRACTION, DRIED

Contact Haemophilia Department at Royal London Hospital for supply

  Powder and solvent for solution for injection
Alprolix (Swedish Orphan Biovitrum Ltd)
Haemonine (Grifols UK Ltd)
Idelvion (CSL Behring UK Ltd)
Refixia (Novo Nordisk Ltd)
Replenine-VF (Bio Products Laboratory Ltd)
Rixubis (Takeda UK Ltd)
  Powder and solvent for solution for infusion
BeneFIX (Pfizer Ltd)
  factor VIII fraction, dried [Specialist drug] Hospital Only
FACTOR VIII FRACTION, DRIED

Contact Haemophilia Department at Royal London Hospital for supply

  Powder and solvent for solution for injection
Factor VIII fraction, dried (Non-proprietary)
Advate (Takeda UK Ltd)
Adynovi (Takeda UK Ltd)
Elocta (Swedish Orphan Biovitrum Ltd)
Esperoct (Novo Nordisk Ltd)
Haemoctin (Grifols UK Ltd)
NovoEight (Novo Nordisk Ltd)
Nuwiq (Octapharma Ltd)
Obizur (Takeda UK Ltd)
Octanate LV (Octapharma Ltd)
ReFacto (Pfizer Ltd)
Voncento (CSL Behring UK Ltd)
  Powder and solvent for solution for infusion
Advate (Takeda UK Ltd)
Wilate 1000 (Octapharma Ltd)
Wilate 500 (Octapharma Ltd)
  factor VIII inhibitor bypassing fraction [Specialist drug] Hospital Only
  Powder and solvent for solution for infusion
FEIBA Imuno (Takeda UK Ltd)
  factor VIIa (recombinant) Hospital Only
FACTOR VIIa (RECOMBINANT)

Off-license use for life-threatening bleeding in non-haemophilliac patients (decision made jointly by consultant anaesthetist/surgeon/physician AND  consultant haematologist)

Availability of haemostatic agents across Barts Health sites

https://weshare.bartshealth.nhs.uk/download.cfm?doc=docm93jijm4n12106&ver=33132

  Powder and solvent for solution for injection
Cevenfacta (LFB Biopharmaceuticals Ltd)
NovoSeven (Novo Nordisk Ltd)
  factor XIII A-subunit (recombinant) [Specialist drug]
  Powder and solvent for solution for injection
NovoThirteen (Novo Nordisk Ltd)
  factor XIII fraction, dried [Specialist drug] Hospital Only
FACTOR XIII FRACTION, DRIED

Contact Haemophilia Department at Royal London Hospital for supply

  Powder and solvent for solution for injection
Fibrogammin P (CSL Behring UK Ltd)
  fibrinogen, dried [Specialist drug] Hospital Only
Availability of haemostatic agents across Barts Health sites

https://weshare.bartshealth.nhs.uk/download.cfm?doc=docm93jijm4n12106&ver=33132

  Powder for solution for infusion
Riastap (CSL Behring UK Ltd)
  Powder and solvent for solution for infusion
FibCLOT (LFB Biopharmaceuticals Ltd)
Fibryga (Octapharma Ltd)
  fresh frozen plasma Hospital Only
  Infusion
OctaplasLG (Octapharma Ltd)
  protein C concentrate [Specialist drug] Hospital Only
  Powder and solvent for solution for injection
Ceprotin (Takeda UK Ltd)
  von Willebrand factor [Specialist drug]
  Powder and solvent for solution for injection
Veyvondi (Takeda UK Ltd) Hospital Only
Vonicog alfa for the treatment and prevention of bleeding in adults with von Willebrand disease

Available for use under Clinical Commissioning Policy: Vonicog alfa for the treatment and prevention of bleeding in adults with von Willebrand disease 

Willfact (LFB Biopharmaceuticals Ltd)
Cardiovascular system / Subarachnoid haemorrhage
  nimodipine Hospital Only
  Solution for infusion
Nimotop (Bayer Plc) On Formulary
  Oral tablet
Nimotop (Bayer Plc)
Cardiovascular system / Heart failure
  Levosimendan Hospital Only
levosimendan in treatment of acute heart failure

For initiation under direction of heart failure consultant - review monograph for dosing advice - NOTE do not give loading dose.

  bendroflumethiazide On Formulary
  Oral tablet
Bendroflumethiazide (Non-proprietary)
  bisoprolol fumarate On Formulary
BISOPROLOL FUMARATE

First-line for heart failure, atrial fibrillation, secondary prevention of MI and stable angina.  
 
Mild to moderate COPD is not a contraindication for use of cardioselective beta blockers such as bisoprolol.
https://www.nice.org.uk/guidance/ng106

https://www.nice.org.uk/guidance/ng136

https://www.nice.org.uk/guidance/ng185

https://www.nice.org.uk/guidance/ng196

https://www.nice.org.uk/guidance/cg126

  Oral tablet
Bisoprolol fumarate (Non-proprietary)
Cardicor (Merck Serono Ltd)
  candesartan cilexetil On Formulary
CANDESARTAN CILEXETIL

Can be used if intolerant to ACE Inhibitor - cough for instance.  Can be used for Heart Failure, post-MI or hypertension

Heart Failure Guidelines
 
https://www.nice.org.uk/guidance/ng106
 
Hypertension Guidelines
 

Secondary prevention of MI Guidelines
 

  Oral tablet
Candesartan cilexetil (Non-proprietary)
Amias (Neon Healthcare Ltd)
  captopril On Formulary
  Oral solution
Captopril (Non-proprietary)
  Oral tablet
Captopril (Non-proprietary)
  chlortalidone Off Formulary
  Oral tablet
Chlortalidone (Non-proprietary)
Hylaton (Morningside Healthcare Ltd)
  co-amilozide Off Formulary
  Oral tablet
Co-amilozide (Non-proprietary)
  co-flumactone Off Formulary
  dapagliflozin On Formulary NICE TA288
NICE TA390
NICE TA418
NICE TA679
NICE TA902
NICE TA775
NICE TA 902 - September 2023 - Dapagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction

Dapagliflozin approved at NEL FPG for treating chronic heart failure with preserved or mildly reduced ejection fraction in line with NICE TA.

  Oral tablet
Forxiga (AstraZeneca UK Ltd)
  digoxin On Formulary
  Oral solution
Digoxin (Non-proprietary)
  Solution for injection
Digoxin (Non-proprietary) Hospital Only
  Solution for infusion
Digoxin (Non-proprietary)
  Oral tablet
Digoxin (Non-proprietary)
  empagliflozin On Formulary NICE TA390
NICE TA336
NICE TA773
NICE TA929
NICE TA942
NICE TA 929 - December 2023 - Empagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction

Empagliflozin approved at NEL FPG for treating chronic heart failure with preserved or mildly reduced ejection fraction

 

Formulary Status: Amber

– To be initiated by or on the recommendation of a specialist

September 2024, Empaglifozin for the treatment of Type 2 Diabetes Mellitus in Children and Young People

Empaglifozin approved at NEL FPG for the treatment of Type 2 Diabetes Mellitus in Children and Young People.

First line SGLT2 Inhibitor in line with NICE Guidance (NG18) 

 

Formulary Status: Amber – specialist initiated 

Empagliflozin- Treatment of symptomatic chronic heart failure with reduced ejection fraction as per NICE TA 773

Approved at DTC July 2022 for the treatment of symptomatic chronic heart failure with reduced ejection fraction

NICE TA 942 - March 2024 - Empagliflozin for treating chronic kidney disease

Empagliflozin Approved at NEL FPG for treating chronic kidney disease

 

Formulary Status: Amber

– To be initiated by or on the recommendation of a specialist

  Oral tablet
Jardiance (Boehringer Ingelheim Ltd)
  enalapril maleate On Formulary
  Oral solution
Enalapril maleate (Non-proprietary)
  Oral tablet
Enalapril maleate (Non-proprietary)
Innovace (Organon Pharma (UK) Ltd)
  enoximone Hospital Only
  Solution for injection
Perfan (Macure Pharma UK Ltd)
  eplerenone On Formulary
EPLERENONE

Eplerenone is used second-line for both heart failure and hypertension if spironolactone not tolerated.
A maximum of 50mg daily of either spironolactone or eplerenone should be used when managing heart failure.
Eplerenone may be used off-licence for those patients who develop gynaecomastia with spironolactone.
Monitor for hyperkalaemia.

Also use for ascites and nephrotic syndrome.

http://www.nyrdtc.nhs.uk/GMMMG/Groups/ipnts/ipnts_recom/ipnts_recom.php

http://guidance.nice.org.uk/CG172

http://publications.nice.org.uk/chronic-heart-failure-cg108


  Oral tablet
Eplerenone (Non-proprietary)
Inspra (Viatris UK Healthcare Ltd)
  fosinopril sodium Off Formulary
  Oral tablet
Fosinopril sodium (Non-proprietary)
  glyceryl trinitrate On Formulary
Transdermal preparations

Prevention of thromobophlebitis in patients requiring emergency parenteral nutrition via peripheral line ('off-label'): apply one (5mg/24hr) patch distal to the venflon

GLYCERYL TRINITRATE

Heart Failure guidelines
 
https://www.nice.org.uk/guidance/ng106
 
Stable angina guidelines


https://www.nice.org.uk/guidance/cg126

 

  Sublingual tablet
Glyceryl trinitrate (Non-proprietary)
  Sublingual spray
Glyceryl trinitrate (Non-proprietary)
Nitrolingual (Beaumont Pharma Ltd)
  Solution for infusion
Glyceryl trinitrate (Non-proprietary)
Note:

Hospital Only

Nitronal (Beaumont Pharma Ltd)
  Transdermal patch
Deponit (Forum Health Products Ltd)
Minitran (Viatris UK Healthcare Ltd)
  Rectal ointment
Rectogesic (Kyowa Kirin International UK NewCo Ltd)
  hydralazine hydrochloride On Formulary
HYDRALAZINE HYDROCHLORIDE

IV FORMULATION IS FOR HOSPITAL USE ONLY

  Powder for solution for injection
Hydralazine hydrochloride (Non-proprietary)
  Oral tablet
Hydralazine hydrochloride (Non-proprietary)
Apresoline (Advanz Pharma)
  isosorbide dinitrate On Formulary
Isosorbide dinitrate in heart failure

Isosorbide dinitrate can be used for treatment of heart failure - usually in combination with hydralazine and usually in those unable to tolerate ACEi due to renal imparment.

  Modified-release tablet
Isoket Retard (Forum Health Products Ltd)
  Solution for injection
Isosorbide dinitrate (Non-proprietary)
Isoket (Forum Health Products Ltd)
  Solution for infusion
Isosorbide dinitrate (Non-proprietary)
  Oral tablet
Isosorbide dinitrate (Non-proprietary)
  isosorbide mononitrate On Formulary
ISOSORBIDE MONONITRATE

Heart Failure guidelines

http://www.nice.org.uk/guidance/CG108

Stable angina guidelines

http://www.nice.org.uk/guidance/CG126

  Modified-release tablet
Isotard XL (Evolan Pharma AB)
Modisal XL (Ennogen Pharma Ltd)
Relosorb XL (Relonchem Ltd)
Xismox XL (Genus Pharmaceuticals Ltd)
  Modified-release capsule
Elantan LA (Forum Health Products Ltd)
Isodur XL (Galen Ltd)
Monomax SR (Martindale Pharmaceuticals Ltd)
  Oral tablet
Isosorbide mononitrate (Non-proprietary)
  ivabradine On Formulary NICE TA267
IVABRADINE

Heart failure: specialist initiation for NYHA II-IV patients in stable congestive heart failure (CHF):
(i.e. sinus rhythm HR 75/min or more, LVEF 35% or less)
Patients should be stable on four weeks of standard therapy with (ACEI, B-Blocker, ARBs)

Ivabradine technology appraisal

http://www.nice.org.uk/guidance/TA267


Stable angina guidelines

http://www.nice.org.uk/guidance/CG126

 

Off license use for postural orthostatic tachycardia syndrome - under specialist initiation only.

  Oral tablet
Ivabradine (Non-proprietary)
Procoralan (Servier Laboratories Ltd)
  lisinopril On Formulary
LISINOPRIL

Heart Failure Guidelines

https://www.nice.org.uk/guidance/ng106

 
Hypertension Guidelines
 
 

Secondary prevention of MI Guidelines
 

  Oral solution
Lisinopril (Non-proprietary) On Formulary
  Oral tablet
Lisinopril (Non-proprietary)
Zestril (Atnahs Pharma UK Ltd)
  losartan potassium On Formulary
LOSARTAN POTASSIUM

Heart Failure Guidelines
 https://www.nice.org.uk/guidance/ng106

 
Hypertension Guidelines

https://pathways.nice.org.uk/pathways/hypertension

 
Secondary prevention of MI Guidelines
 

  Oral tablet
Losartan potassium (Non-proprietary)
Cozaar (Organon Pharma (UK) Ltd)
  milrinone On Formulary
Milrinone IV Monograph (Adult Critical Care Only)

For use in Adult Critical Care areas only.

  Solution for injection
Milrinone (Non-proprietary)
  Solution for infusion
Milrinone (Non-proprietary)
Primacor (Sanofi)
  nebivolol On Formulary
NEBIVOLOL

Specialist initiation with PEFR monitoring in hospital. (NB: mild to moderate COPD is not a contraindication for use of other cardioselective beta blockers)

Highly cardioselective beta blocker.

Can be initiated at 1.25mg (quarter of a 5mg tablet) can be considered in patients with severe asthma or COPD.

  Oral tablet
Nebivolol (Non-proprietary)
Nebilet (A. Menarini Farmaceutica Internazionale SRL)
  perindopril arginine Off Formulary
  Oral tablet
Coversyl Arginine (Servier Laboratories Ltd)
  perindopril erbumine On Formulary
PERINDOPRIL ERBUMINE

Heart Failure Guidelines
 
https://www.nice.org.uk/guidance/ng106
 
Hypertension Guidelines
 
https://pathways.nice.org.uk/pathways/hypertension
 
Secondary prevention of MI Guidelines
 

  Oral tablet
Perindopril erbumine (Non-proprietary)
  prazosin Off Formulary
  Oral tablet
Prazosin (Non-proprietary)
Hypovase (Pfizer Ltd)
  quinapril Off Formulary
  Oral tablet
Quinapril (Non-proprietary)
Accupro (Pfizer Ltd)
  ramipril On Formulary
RAMIPRIL

First-line ACEI for hypertension, heart failure, secondary prevention of MI.

Heart Failure Guidelines

https://www.nice.org.uk/guidance/ng106
 
Hypertension Guidelines
 
https://pathways.nice.org.uk/pathways/hypertension
 
Secondary prevention of MI Guidelines 

https://pathways.nice.org.uk/pathways/myocardial-infarction-rehabilitation-and-preventing-further-cardiovascular-disease

  Oral solution
Ramipril (Non-proprietary) On Formulary
RAMIPRIL

First-line ACEI for hypertension, heart failure, secondary prevention of MI.

Heart Failure Guidelines

http://www.nice.org.uk/guidance/cg108

Hypertension Guidelines

http://www.nice.org.uk/guidance/CG127

Secondary prevention of MI Guidelines

http://www.nice.org.uk/guidance/cg172

  Oral tablet
Ramipril (Non-proprietary)
Tritace (Sanofi)
  Oral capsule
Ramipril (Non-proprietary)
  sacubitril with valsartan On Formulary NICE TA388
Sacubitril valsartan NICE TA 388

Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction, NICE TA388:

https://www.nice.org.uk/Guidance/TA388

  Oral tablet
Entresto (Novartis Pharmaceuticals UK Ltd)
  sodium nitroprusside Hospital Only
  Powder and solvent for solution for infusion
Sodium nitroprusside (Non-proprietary)
  spironolactone On Formulary
SPIRONOLACTONE

Hypertension: Consider further diuretic therapy with low-dose spironolactone (25 mg once daily)  if the blood potassium level is 4.5 mmol/l or lower. Use particular caution in people with a reduced estimated glomerular filtration rate because they have an increased risk of hyperkalaemia. NICE CG 127

Heart failure: with preserved ejection fraction as determined by specialist.  NICE CG 108

Ascites, nephrotic syndrome, Conn's syndrome (300mg-600mg per day)

Doses above 100mg daily may be associated with impotence in males.

  Oral solution
Spironolactone (Non-proprietary)
  Oral tablet
Spironolactone (Non-proprietary)
Aldactone (Pfizer Ltd)
  valsartan On Formulary
VALSARTAN

Last-line option post-MI

Heart Failure Guidelines
 
https://www.nice.org.uk/guidance/ng106
 
Hypertension Guidelines
 
https://pathways.nice.org.uk/pathways/hypertension
 
Secondary prevention of MI Guidelines
 

  Oral solution
Diovan (Novartis Pharmaceuticals UK Ltd)
  Oral tablet
Valsartan (Non-proprietary)
  Oral capsule
Valsartan (Non-proprietary)
  vericiguat
  Oral tablet
Verquvo (Bayer Plc)
Cardiovascular system / Myocardial ischaemia
  acebutolol Off Formulary
  Oral tablet
Acebutolol (Non-proprietary)
  amlodipine On Formulary
AMLODIPINE

First-line dihydropyridine calcium channel blocker for hypertension.  

Can be considered for stable angina.

Stable Angina guidelines
 
https://www.nice.org.uk/guidance/cg126
 
Hypertension guidelines


https://www.nice.org.uk/guidance/ng136


 

  Oral suspension
Amlodipine (Non-proprietary) Off Formulary
Liquid prep- hospital only

Liquid prep to be used on the advice of clinical pharmacologist

  Oral solution
Amlodipine (Non-proprietary)
  Oral tablet
Amlodipine (Non-proprietary)
Istin (Viatris UK Healthcare Ltd)
  aspirin On Formulary
Aspirin

Should not routinely used for primary prevention of cardiovascular disease.

Enteric coated aspirin should not be used as it has a poor cost:benefit ratio. There is no convincing evidence that it reduces gastrointestinal bleeding (Drug Ther Bulletin, Jan 1997, p.7-8) and it has a lower bioavailability vs dispersable.

Gastroprotection with lansoprazole is advised.

 

Aspirin has multiple indications, follow the links below for more information


Unstable angina and NSTEMI guidelines

http://www.nice.org.uk/guidance/CG94

Stroke guidelines

http://www.nice.org.uk/Guidance/CG68

STEMI guidelines

http://www.nice.org.uk/guidance/CG167

AF guidelines

http://www.nice.org.uk/guidance/cg180

Hypertension in pregnancy guidelines

http://www.nice.org.uk/guidance/CG107

  Dispersible tablet
Aspirin (Non-proprietary)
Disprin (Reckitt Benckiser Healthcare (UK) Ltd)
  Gastro-resistant tablet
Aspirin (Non-proprietary)
Nu-Seals (Alliance Pharmaceuticals Ltd)
  Suppository
Aspirin (Non-proprietary)
  Oral tablet
Aspirin (Non-proprietary)
  atenolol On Formulary
  Oral solution
Atenolol (Non-proprietary)
  Solution for injection
Tenormin (Atnahs Pharma UK Ltd) Off Formulary
  Oral tablet
Atenolol (Non-proprietary)
Tenormin (Atnahs Pharma UK Ltd)
  bisoprolol fumarate On Formulary
BISOPROLOL FUMARATE

First-line for heart failure, atrial fibrillation, secondary prevention of MI and stable angina.  
 
Mild to moderate COPD is not a contraindication for use of cardioselective beta blockers such as bisoprolol.
https://www.nice.org.uk/guidance/ng106

https://www.nice.org.uk/guidance/ng136

https://www.nice.org.uk/guidance/ng185

https://www.nice.org.uk/guidance/ng196

https://www.nice.org.uk/guidance/cg126

  Oral tablet
Bisoprolol fumarate (Non-proprietary)
Cardicor (Merck Serono Ltd)
  bivalirudin Hospital Only
Heparin Induced Thrombocytopenia (HIT)

https://weshare.bartshealth.nhs.uk/haematology-immunology?media_item=16727&media_type=10#file-viewer

  Powder for solution for infusion
Bivalirudin (Non-proprietary)
  cangrelor Off Formulary
  Powder for solution for injection
Kengrexal (Chiesi Ltd)
  carvedilol On Formulary
CARVEDILOL

Can be used as second-line beta blocker (after bisoprolol) for heart failure, atrial fibrillation, hypertension, secondary prevention of MI and stable angina.

  Oral tablet
Carvedilol (Non-proprietary)
  diltiazem hydrochloride On Formulary
DILTIAZEM HYDROCHLORIDE

 
***Please specify the BRAND NAME as there are differences in bioavailability***

Secondary prevention of MI

http://www.nice.org.uk/Guidance/CG48

Atrial fibrillation

http://www.nice.org.uk/guidance/cg180

Stable angina

http://www.nice.org.uk/guidance/CG126

  Modified-release tablet
Diltiazem hydrochloride (Non-proprietary) On Formulary
Retalzem (Kent Pharma (UK) Ltd)
Tildiem (Sanofi)
Tildiem Retard (Sanofi)
Zeyam (Ennogen Pharma Ltd)
  Modified-release capsule
Adizem-SR (Napp Pharmaceuticals Ltd)
Adizem-XL (Napp Pharmaceuticals Ltd)
Angitil SR (Ethypharm UK Ltd)
Angitil XL (Ethypharm UK Ltd)
Slozem (Zentiva Pharma UK Ltd)
Tildiem LA (Sanofi)
Viazem XL (Thornton & Ross Ltd)
Zemtard XL (Galen Ltd)
  eptifibatide Hospital Only
Antiplatelet and eptifibatide advice in Acute Coronary Syndromes

Refer to local monograph for use in cath labs - Note unlicensed dosing of two loading doses (180mcg/kg) given 10 minutes apart with concomitent infusion 2microgram/kg/min usually for 6 hours post procedure or upto 24 hours if high thrombus burden.

  Solution for injection
Eptifibatide (Non-proprietary)
  Solution for infusion
Eptifibatide (Non-proprietary)
  felodipine On Formulary
  Modified-release tablet
Cardioplen XL (Chiesi Ltd)
Delofine XL (Morningside Healthcare Ltd)
Felendil XL (Teva UK Ltd)
Felotens XL (Thornton & Ross Ltd)
Neofel XL (Kent Pharma (UK) Ltd)
Parmid XL (Sandoz Ltd)
Pinefeld XL (Tillomed Laboratories Ltd)
Vascalpha (Accord-UK Ltd)
  fondaparinux sodium On Formulary
Fondaparinux in acute coronary syndrome

Fondaparinux is now the trusts formulary choice of anticoagulant in NSTEMI-ACS.

Dose 2.5mg ONCE DAILY

Mode of administration Subcutaneous

If undergoing PCI Preferably undergo PCI 4 - 24 hours after receiving the last fondaparinux dose and use UFH as an adjunct as per current practice. 

USE ALTERNATIVE anticoagulant if patient has a pre existing medical condition requiring anticoagulation - i.e. AF, DVT, mechanical valve etc - use enoxaparin 1mg/kg twice daily (adjusted for renal function).

To stop post angioplasty unless clinically indicated

Platelet monitoring Not required

Contra-indication CrCl <20mls/mins if known, and use UFH

FONDAPARINUX SODIUM

For acute coronary syndrome

Heparin Induced Thrombocytopenia (HIT)

https://weshare.bartshealth.nhs.uk/haematology-immunology?media_item=16727&media_type=10#file-viewer

  Solution for injection
Fondaparinux sodium (Non-proprietary) On Formulary
Fondaparinux in acute coronary syndrome

Fondaparinux is now the trusts formulary choice of anticoagulant in NSTEMI-ACS.

Dose 2.5mg ONCE DAILY

Mode of administration Subcutaneous

If undergoing PCI Preferably undergo PCI 4 - 24 hours after receiving the

last fondaparinux dose and use UFH as an adjunct as

per current practice.

To stop post angioplasty unless clinically indicated

Platelet monitoring Not required

Contra-indication CrCl <20mls/mins if known, and use UFH

Arixtra (Viatris UK Healthcare Ltd) On Formulary
Fondaparinux in acute coronary syndrome

Fondaparinux is now the trusts formulary choice of anticoagulant in NSTEMI-ACS.

Dose 2.5mg ONCE DAILY

Mode of administration Subcutaneous

If undergoing PCI Preferably undergo PCI 4 - 24 hours after receiving the

last fondaparinux dose and use UFH as an adjunct as

per current practice.

To stop post angioplasty unless clinically indicated

Platelet monitoring Not required

Contra-indication CrCl <20mls/mins if known, and use UFH

  glyceryl trinitrate On Formulary
Transdermal preparations

Prevention of thromobophlebitis in patients requiring emergency parenteral nutrition via peripheral line ('off-label'): apply one (5mg/24hr) patch distal to the venflon

GLYCERYL TRINITRATE

Heart Failure guidelines
 
https://www.nice.org.uk/guidance/ng106
 
Stable angina guidelines


https://www.nice.org.uk/guidance/cg126

 

  Sublingual tablet
Glyceryl trinitrate (Non-proprietary) On Formulary
  Sublingual spray
Glyceryl trinitrate (Non-proprietary) On Formulary
Nitrolingual (Beaumont Pharma Ltd) On Formulary
  Solution for infusion
Glyceryl trinitrate (Non-proprietary) On Formulary
Note:

Hospital Only

Nitronal (Beaumont Pharma Ltd)
Note:

Hospital Only

  Transdermal patch
Deponit (Forum Health Products Ltd) On Formulary
Minitran (Viatris UK Healthcare Ltd)
  Rectal ointment
Rectogesic (Kyowa Kirin International UK NewCo Ltd)
  ivabradine On Formulary NICE TA267
IVABRADINE

Heart failure: specialist initiation for NYHA II-IV patients in stable congestive heart failure (CHF):
(i.e. sinus rhythm HR 75/min or more, LVEF 35% or less)
Patients should be stable on four weeks of standard therapy with (ACEI, B-Blocker, ARBs)

Ivabradine technology appraisal

http://www.nice.org.uk/guidance/TA267


Stable angina guidelines

http://www.nice.org.uk/guidance/CG126

 

Off license use for postural orthostatic tachycardia syndrome - under specialist initiation only.

  Oral tablet
Ivabradine (Non-proprietary)
Procoralan (Servier Laboratories Ltd)
  metoprolol tartrate On Formulary
METOPROLOL TARTRATE

Initiation for atrial fibrillation, hypertension, secondary prevention of MI, heart failure, stable angina.

Note: Metoprolol initiated until stable and then changed to a less frequent dosage regime.

Alternative for hypertension in pregnancy.

https://www.nice.org.uk/guidance/ng185

https://www.nice.org.uk/guidance/ng196

https://www.nice.org.uk/guidance/ng133

https://www.nice.org.uk/guidance/cg126

 

 

  Solution for injection
Betaloc (Recordati Pharmaceuticals Ltd) Hospital Only
  Oral tablet
Metoprolol tartrate (Non-proprietary)
  nadolol Off Formulary
  Oral tablet
Nadolol (Non-proprietary)
  nicardipine hydrochloride Off Formulary
  Solution for infusion
Nicardipine hydrochloride (Non-proprietary) Off Formulary
  Oral capsule
Cardene (Laboratoire X.O)
  nicorandil On Formulary
NICORANDIL

Second-line for angina (after nitrates).

Ivabradine technology appraisal

http://www.nice.org.uk/guidance/TA267

Stable angina guidelines

http://www.nice.org.uk/guidance/CG126

  Oral tablet
Nicorandil (Non-proprietary)
  nifedipine On Formulary
Leiomyoma pain

Nidfedipine 10-20mg daily or twice daily is used in dermatology for pain resulting from leiomyoma

  Modified-release tablet
Adalat LA (Bayer Plc) On Formulary
Leiomyoma pain

Nidfedipine 10-20mg daily or twice daily is used in dermatology for pain resulting from leiomyoma

Adanif XL (Advanz Pharma)
Adipine MR (Chiesi Ltd)
Adipine XL (Chiesi Ltd)
Dexipress MR (Dexcel-Pharma Ltd)
Fortipine LA (Advanz Pharma)
Neozipine XL (Kent Pharma (UK) Ltd)
Nifedipress MR (Dexcel-Pharma Ltd)
Tensipine MR (Genus Pharmaceuticals Ltd)
Valni Retard (Tillomed Laboratories Ltd)
  Modified-release capsule
Coracten SR (Teofarma S.r.l.)
Coracten XL (Teofarma S.r.l.)
  Oral drops
Nifedipine (Non-proprietary)
  Oral capsule
Nifedipine (Non-proprietary)
  perindopril erbumine with amlodipine
  pindolol Off Formulary
  propranolol hydrochloride On Formulary
PROPRANOLOL HYDROCHLORIDE

Phaechromocytoma (usually started 24 hours after Phenoxybenzamine)

Also used orally for cutaneous haemangioma where topical timolol not appropriate.

For use in the management of acute alcohol withdrawal-see 'Alcohol dependence https://www.formularycomplete.com/view/treatmentsummary/monograph/848264 

PROPRANOLOL for thyrotoxicosis

Symptomatic relief of thyrotoxicosis-

  Modified-release capsule
Bedranol SR (Almus Pharmaceuticals Ltd, Sandoz Ltd)
Propranolol

Whipps Cross: somatic manifestations of acute alcohol withdrawal-  see alcohol dependance for more information
 

Beta-Prograne (Accord-UK Ltd, Tillomed Laboratories Ltd)
Half Beta-Prograne (Accord-UK Ltd, Tillomed Laboratories Ltd)
  Oral solution
Propranolol hydrochloride (Non-proprietary) On Formulary
  Oral tablet
Propranolol hydrochloride (Non-proprietary)
  ranolazine On Formulary
RANOLAZINE

Third-line option for stable angina.
 
  
Stable angina guidelines

http://www.nice.org.uk/guidance/CG126

  Modified-release tablet
Ranolazine (Non-proprietary)
Ranexa (A. Menarini Farmaceutica Internazionale SRL) On Formulary
  timolol maleate Off Formulary
  Eye drops
Timolol maleate (Non-proprietary)
Eysano (Aspire Pharma Ltd)
Timoptol (Santen UK Ltd)
Tiopex (Thea Pharmaceuticals Ltd)
Once-daily preparations

Long acting preparations of timolol are used in dermatology for cutaneous haemangioma

  Eye gel
Timoptol-LA (Santen UK Ltd)
  Oral tablet
Timolol maleate (Non-proprietary)
  tirofiban Hospital Only
  Infusion
Tirofiban (Non-proprietary)
Aggrastat (Advanz Pharma)
  Solution for infusion
Aggrastat (Advanz Pharma)
  verapamil hydrochloride On Formulary
VERAPAMIL HYDROCHLORIDE

For rate controlled angina.
 

 
Atrial fibrillation

https://www.nice.org.uk/guidance/ng196

Stable angina 

https://www.nice.org.uk/guidance/cg126

  Modified-release tablet
Half Securon (Viatris UK Healthcare Ltd)
Securon SR (Viatris UK Healthcare Ltd)
Vera-Til SR (Accord-UK Ltd, Tillomed Laboratories Ltd)
Verapress MR (Dexcel-Pharma Ltd)
  Oral solution
Verapamil hydrochloride (Non-proprietary) On Formulary
  Solution for injection
Securon (Viatris UK Healthcare Ltd) Hospital Only
  Oral tablet
Verapamil hydrochloride (Non-proprietary)
Cardiovascular system / Acute coronary syndromes
  alteplase Hospital Only NICE TA264
PE guidelines

See below for link to guidelines

ALTEPLASE

For treatment of stroke and PE

Alteplase for treating acute ischaemic stroke guidelines

http://www.nice.org.uk/guidance/TA264

Thrombolysis with Alteplase

.

  Powder and solvent for solution for injection
Actilyse (Boehringer Ingelheim Ltd) Hospital Only
  Powder and solvent for solution for infusion
Actilyse (Boehringer Ingelheim Ltd) Hospital Only
  captopril
  Oral solution
Captopril (Non-proprietary)
  Oral tablet
Captopril (Non-proprietary)
  clopidogrel On Formulary NICE TA210
Antiplatelet and eptifibatide advice in Acute Coronary Syndromes

CLOPIDOGREL

First-line monotherapy after acute phase for ischaemic stroke in absence of atrial fibrillation.  Assess bleeding risk for co-prescription of PPIs. 
NB: Omeprazole should not be used with clopidogrel.

For secondary prevention of cardiosvascular disease if aspirin contraindicated or not tolerated.

Can be used where aspirin contraindicated for any indication.

Indicate course length on communications if combined with other antithrombotic therapy, i.e. for 12 months post acute MI as dual antiplatelet therapy (with aspirin).

Commonly loaded with 600mg prior to coronary artery stenting (with or with out ACS) - NOTE this is an unlicensed dose 

Consider lansoprazole or H2 antagonists (ranitidine) as gastroprotection with clopidogrel treatment.

Clopidogrel and Dipyridamole M/R use in prophylaxis technology appraisal

http://www.nice.org.uk/guidance/TA210

  Oral tablet
Clopidogrel (Non-proprietary)
Plavix (Sanofi)
  dalteparin sodium Off Formulary
  Solution for injection
Fragmin (Pfizer Ltd)
  enoxaparin sodium On Formulary
LMWH Shared Care Guideline

LMWH Shared Care Guideline

GUIDELINES

See below for links to guidelines

Transfer of Care document - Treatment of PE in COVID patients

see attached

Peri-operative management

Peri-operative management

Anticoagulation Contacts

Scroll down for links to documents on the fileshare

  Solution for injection
Arovi (ROVI Biotech Ltd)
Clexane (Sanofi) On Formulary
Anticoagulation intranet page

Scroll down for links to documents on the fileshare

Enoxaparin shared care guidelines

Inhixa (Techdow Pharma England Ltd)
Ledraxen (Tetris Pharma Ltd)
  glyceryl trinitrate On Formulary
Transdermal preparations

Prevention of thromobophlebitis in patients requiring emergency parenteral nutrition via peripheral line ('off-label'): apply one (5mg/24hr) patch distal to the venflon

GLYCERYL TRINITRATE

Heart Failure guidelines
 
https://www.nice.org.uk/guidance/ng106
 
Stable angina guidelines


https://www.nice.org.uk/guidance/cg126

 

  Sublingual tablet
Glyceryl trinitrate (Non-proprietary) On Formulary
  Sublingual spray
Glyceryl trinitrate (Non-proprietary) On Formulary
Nitrolingual (Beaumont Pharma Ltd) On Formulary
  Solution for infusion
Glyceryl trinitrate (Non-proprietary) On Formulary
Note:

Hospital Only

Nitronal (Beaumont Pharma Ltd)
Note:

Hospital Only

  Transdermal patch
Deponit (Forum Health Products Ltd) On Formulary
Minitran (Viatris UK Healthcare Ltd)
  Rectal ointment
Rectogesic (Kyowa Kirin International UK NewCo Ltd)
  heparin (unfractionated) On Formulary
Unfractionated Heparin (UFH): Monitoring in Adult Patients

 See below

  Solution for injection
Heparin (unfractionated) (Non-proprietary)
Heparin dose and rate adjustment according to APTT

At legacy BLT: IV infusion: Draw up 40ml of 1000units in 1ml heparin into a syringe (40,000units in 40ml).  Administer by continuous infusion according to the patient’s weight, at the rate as stated below:
Weight Rate(2) - mls per hour
of 1000units in 1ml concentration Greater than 90kg 1.7 81-90kg 1.6 71-80kg 1.4 61-70kg 1.2 51-60kg 1.0 41-50kg 0.8

 

Heparin dose and rate adjustment according to APTT

At legacy BLT: IV infusion: Draw up 40ml of 1000units in 1ml heparin into a syringe (40,000units in 40ml).  Administer by continuous infusion according to the patient’s weight, at the rate as stated below:
Weight Rate(2) - mls per hour
of 1000units in 1ml concentration Greater than 90kg 1.7 81-90kg 1.6 71-80kg 1.4 61-70kg 1.2 51-60kg 1.0 41-50kg 0.8

 

Guidelines for the Diagnosis, Investigation and Management of Heparin-Induced Thrombocytopenia (HIT) Guidelines for the Diagnosis, Investigation and Management of Heparin-Induced Thrombocytopenia (HIT)

HIT Guidelines 2016

  Infusion
Heparin (unfractionated) (Non-proprietary)
Heparin dose and rate adjustment according to APTT

At legacy BLT: IV infusion: Draw up 40ml of 1000units in 1ml heparin into a syringe (40,000units in 40ml).  Administer by continuous infusion according to the patient’s weight, at the rate as stated below:

Weight Rate(2) - mls per hour
of 1000units in 1ml concentration Greater than 90kg 1.7 81-90kg 1.6 71-80kg 1.4 61-70kg 1.2 51-60kg 1.0 41-50kg 0.8

  Form unstated
Heparin (unfractionated) (Non-proprietary)
  isosorbide dinitrate Off Formulary
Isosorbide dinitrate in heart failure

Isosorbide dinitrate can be used for treatment of heart failure - usually in combination with hydralazine and usually in those unable to tolerate ACEi due to renal imparment.

  Modified-release tablet
Isoket Retard (Forum Health Products Ltd)
  Solution for injection
Isosorbide dinitrate (Non-proprietary)
Isoket (Forum Health Products Ltd)
  Solution for infusion
Isosorbide dinitrate (Non-proprietary)
  Oral tablet
Isosorbide dinitrate (Non-proprietary)
  isosorbide mononitrate On Formulary
ISOSORBIDE MONONITRATE

Heart Failure guidelines

http://www.nice.org.uk/guidance/CG108

Stable angina guidelines

http://www.nice.org.uk/guidance/CG126

  Modified-release tablet
Isotard XL (Evolan Pharma AB)
Modisal XL (Ennogen Pharma Ltd)
Relosorb XL (Relonchem Ltd)
Xismox XL (Genus Pharmaceuticals Ltd)
  Modified-release capsule
Elantan LA (Forum Health Products Ltd)
Isodur XL (Galen Ltd)
Monomax SR (Martindale Pharmaceuticals Ltd)
  Oral tablet
Isosorbide mononitrate (Non-proprietary)
  lisinopril On Formulary
LISINOPRIL

Heart Failure Guidelines

https://www.nice.org.uk/guidance/ng106

 
Hypertension Guidelines
 
 

Secondary prevention of MI Guidelines
 

  Oral solution
Lisinopril (Non-proprietary) On Formulary
  Oral tablet
Lisinopril (Non-proprietary)
Zestril (Atnahs Pharma UK Ltd)
  perindopril arginine Off Formulary
  Oral tablet
Coversyl Arginine (Servier Laboratories Ltd)
  perindopril erbumine On Formulary
PERINDOPRIL ERBUMINE

Heart Failure Guidelines
 
https://www.nice.org.uk/guidance/ng106
 
Hypertension Guidelines
 
https://pathways.nice.org.uk/pathways/hypertension
 
Secondary prevention of MI Guidelines
 

  Oral tablet
Perindopril erbumine (Non-proprietary)
  prasugrel On Formulary NICE TA317
PRASUGREL

Specialist initiation for acute coronary syndrome - third line after other P2Y12 inhibitors not tolerated or unable to be used due to interactions.


To be used in combination with aspirin.

Approved for neurovascular stenting for patients who are resistant to clopidogrel

Approved September DTC 2021

  Oral tablet
Prasugrel (Non-proprietary)
Efient (Vygoris Ltd)
  ramipril On Formulary
RAMIPRIL

First-line ACEI for hypertension, heart failure, secondary prevention of MI.

Heart Failure Guidelines

https://www.nice.org.uk/guidance/ng106
 
Hypertension Guidelines
 
https://pathways.nice.org.uk/pathways/hypertension
 
Secondary prevention of MI Guidelines 

https://pathways.nice.org.uk/pathways/myocardial-infarction-rehabilitation-and-preventing-further-cardiovascular-disease

  Oral solution
Ramipril (Non-proprietary) On Formulary
RAMIPRIL

First-line ACEI for hypertension, heart failure, secondary prevention of MI.

Heart Failure Guidelines

http://www.nice.org.uk/guidance/cg108

Hypertension Guidelines

http://www.nice.org.uk/guidance/CG127

Secondary prevention of MI Guidelines

http://www.nice.org.uk/guidance/cg172

  Oral tablet
Ramipril (Non-proprietary)
Tritace (Sanofi)
  Oral capsule
Ramipril (Non-proprietary)
  streptokinase Hospital Only
Streptokinase

This is a second line agent - please consider use of first line agent such as tenectoplase or alteplase depending on the indication - see seperate monograph for more information.

  Powder for solution for infusion
Streptokinase (Non-proprietary)
  tenecteplase Hospital Only
September 2024, NICE TA 990 Tenecteplase for treating acute ischaemic stroke

Tenecteplase approved at NEL FPG for treating acute ischaemic stroke in line with NICE TA.

 

Formulary Status: Hospital Only

  Powder and solvent for solution for injection
Tenecteplase (Non-proprietary)
Metalyse (Boehringer Ingelheim Ltd) On Formulary
Fibrinolysis with tenecteplase BHC Nov 2015

  ticagrelor On Formulary NICE TA236
NICE TA420
Antiplatelet and eptifibatide advice in Acute Coronary Syndromes

  Orodispersible tablet
Brilique (AstraZeneca UK Ltd)
  Oral tablet
Brilique (AstraZeneca UK Ltd)
  trandolapril Off Formulary
  Oral capsule
Trandolapril (Non-proprietary)
  valsartan On Formulary
VALSARTAN

Last-line option post-MI

Heart Failure Guidelines
 
https://www.nice.org.uk/guidance/ng106
 
Hypertension Guidelines
 
https://pathways.nice.org.uk/pathways/hypertension
 
Secondary prevention of MI Guidelines
 

  Oral solution
Diovan (Novartis Pharmaceuticals UK Ltd)
  Oral tablet
Valsartan (Non-proprietary)
  Oral capsule
Valsartan (Non-proprietary)
Cardiovascular system / Cardiac arrest
  adrenaline/epinephrine On Formulary
MHRA Alert Oct 2019

The Medicines & Healthcare products Regulatory Agency (MHRA) has received reports of Emerade pens failing to activate. The product is not being recalled, instead the attached patient information should be given to patients who use this product.

Further information on the alert can be found: https://www.gov.uk/drug-device-alerts/class-4-medicines-defect-information-emerade-150-300-and-500-microgram-solution-for-injection-in-pre-filled-syringe-mdr-57-08-19?utm_source=f03b2ee9-32c9-4c29-9dde-a224560325d3&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate

Patients experiencing any problem with Emerade failing to activate should report this via the MHRA’s Yellow Card Scheme and keep the pen for further examination.

Adrenaline auto-injector shortage

There is an on-going supply issue with Emerade devices, which is affecting the stock of all other brands of adrenaline auto-injectors.

 

Please refer to the below memo for further information.

  Solution for injection
Adrenaline/epinephrine (Non-proprietary) On Formulary
EpiPen (Viatris UK Healthcare Ltd) On Formulary
Jext (ALK-Abello Ltd) On Formulary