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Joint Formulary
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.01  Positive inotropic drugs
02.01.01  Cardiac glycosides
Digoxin
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Formulary
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Provider notes

  • NMUH:
    • NB. The Digoxin 100 micrograms/mL (Paediatric) is unlicensed and NON-FORMULARY. 
  • RFL:
    • No restriction stated
  • RNOH:
    • Tablets available. Oral elixir available as 50 micrograms/mL
  • UCLH:
  • WH:
    • No restriction stated
 
02.01.01  Digoxin-specific antibody
Digoxin specific antibody fragments
(Digifab®)
(Cardiac glycoside (digoxin) toxicity)
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Formulary
High Cost Medicine
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
02.01.02  Phosphodiesterase type-3 inhibitors
Enoximone
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Formulary
GP - Red
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Milrinone infusion
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Formulary
GP - Red
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Approved for acute decompensated right sided heart failure or refractory severe congestive heart failure, short term use only (JFC July 2020).

Provider notes

  • NMUH:
    • Restricted to Critical Care and Cardiology
  • RFL:
    • Restricted to Critical Care and Cardiology
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to Critical Care and Cardiology 
 
02.02  Diuretics to top
02.02.01  Thiazides and related diuretics
Bendroflumethiazide
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Indapamide
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Indapamide modified release
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Metolazone
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
02.02.02  Loop diuretics
Furosemide
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Bumetanide
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
02.02.03  Potassium-sparing diuretics and aldosterone antagonists
Amiloride Hydrochloride
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
02.02.03  Aldosterone antagonists
Spironolactone
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Formulary
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Provider notes

  • NMUH:
    • Check for MHRA Drug Safety Updates
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Eplerenone
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Restricted Drug Restricted
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Approved for heart failure in patients unable to tolerate spironolactone due to gynaecomastia (JFC April 2017)

Provider notes

  • NMUH:
    • Check for MHRA Drug Safety Updates
    • Restricted for patients who are unable to tolerate spironolactone due to gynaecomastia
  • RFL:
    • Restricted to cardiology for:
      • Heart failure in patients unable to tolerate spironolactone due to gynaecomastia
      • Ejection Fraction <40% post STEMI
  • RNOH:
    • Requires CARDIOLOGIST approval
  • UCLH:
    • Restricted to patients intolerant of spironolactone due to gynacomastia
  • WH:
    • Eplerenone is reserved for the use of Consultant Cardiologists only for those who develop gynecomastia with spironolactone
 
02.02.04  Potassium-sparing diuretics with other diuretics to top
Co-amilofruse
(Furosemide + Amiloride)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Co-amilozide
(Amiloride + Hydrochlorothiazide)
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
02.02.05  Osmotic diuretics
Mannitol IV
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • 10% and 20% (500 mL)
  • UCLH:
  • WH:
    • No restriction stated
 
02.02.06  Mercurial diuretics
02.02.07  Carbonic anhydrase inhibitors
02.02.08  Diuretics with potassium
02.03  Anti-arrhythmic drugs to top
02.03.01  Management of arrhythmias
02.03.02  Drugs for arrhythmias
02.03.02  Supraventricular arrhythmias
Adenosine 6mg/2mL injection
(Adenocor®)
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Dronedarone
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Formulary
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Provider notes

  • NMUH:
    • NOT 1ST LINE DRUG - REQUIRES CARDIOLOGIST APPROVAL.
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used  in line with NICE recommendations and/or Local Trust Guidelines.
  • RFL:
    • Cardiology initiation only – use as per NICE TA
  • RNOH:
    • Requires CARDIOLOGIST approval
  • UCLH:
  • WH:
    • For use in the treatment of Non‐Permanent Atrial Fibrillation (AF) where it is not the first‐line option; this is use is limited to an SpR or a Consultant cardiologist who has seen the patient.
 
Link  NICE TA197: Atrial fibrillation - dronedarone
02.03.02  Supraventricular and ventricular arrhythmias
Amiodarone
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Disopyramide immediate release
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Cardiology only
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Disopyramide modified release
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Cardiology only
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Flecainide
(Arrhythmias )
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Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Propafenone
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to cardiology
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
02.03.02  Ventricular arrhythmias to top
Lidocaine injection
(Cardiac)
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Formulary
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

 Provider notes

  • NMUH:
    • Ampoules are Formulary but infusions are non formulary.
  • RFL:
    • Lidocaine ampoules and infusion available
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
02.04  Beta-adrenoceptor blocking drugs
Atenolol
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Tablets available. Oral syrup available as 5 mg/mL
  • UCLH:
  • WH:
    • Tabs 50 mg, 100 mg; Syrup 25 mg/5 ml
 
Bisoprolol
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Carvedilol
(Cardiology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Co-tenidone
(Atenolol + Chlortalidone )
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Esmolol
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Only 100mg/10ml vials are kept at NMUHT.
  • RFL:
    • Restricted to ITU, cardiology and theatres only.
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Labetalol
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Tablets – no restriction
    • Infusion – following local protocol
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Metoprolol
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Nebivolol
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Cardiology use only
    • Second-line treatment for patients intolerant of or failed bisoprolol/metoprolol for heart failure
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Propranolol
(Cardiology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Immediate release or modified release.

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Sotalol
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Tablets 40mg, 80mg only
 
02.05  Drugs affecting the renin-angiotensin system and some other antihypertensive drugs
02.05.01  Vasodilator antihypertensive drugs
Ambrisentan
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Restricted Drug Restricted
GP - Red
High Cost Medicine
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Prior funding approval required. Restricted to the treatment of pulmonary hypertension
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Bosentan
(Pulmonary hypertension)
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Restricted Drug Restricted
GP - Red
High Cost Medicine
NHS England
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Prior funding approval required
    • Restricted to the treatment of pulmonary hypertension
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NHSE A11/P/c: Targeted Therapies for use in Pulmonary Hypertension in Adults
Bosentan
(Digital ulceration)
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Restricted Drug Restricted
GP - Red
High Cost Medicine
NHS England
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for digital ulceration in systemic sclerosis in line with NHSE Clinical Commissioning Policy A13/P/e (May 2015)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • In line with NHSE clinical comissioning policy
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NHSE A13/P/e: Sildenafil and bosentan for the treatment of digital ulceration in systemic sclerosis
Hydralazine
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Red Hydralazine injection is for hospital prescribing only

Grey Hydralazine tablets have no restriction for primary care

 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Iloprost injection
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GP - Red
High Cost Medicine
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for use in pulmonary hypertension, scleroderma and peripheral vascular disease - see local protocols
    • Also approved for use on ITU
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Available on named patient basis only.  Contact pharmacy for further information
 
Iloprost nebules
(Ventavis®)
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GP - Red
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Approved for COVID-19 associated ARDS with refractory hypoxaemia, in line with COVID-19 Speciality guide for critical care (see JFC Position Statement).

Provider notes

  • NMUH:
    • Non-formulary (use epoprostenol for COVID-19 associated ARDS)
  • RFL:
    • RFH: Restricted to critical care and used in ARDS with refractory hypoxaemia only
    • BCH: Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Link  NCL JFC: Nebulised iloprost or epoprostenol for COVID-19 associated ARDS Position Statement
Macitentan
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Restricted Drug Restricted
GP - Red
High Cost Medicine
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Prior funding approval required
    • Restricted to the treatment of pulmonary hypertension
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Minoxidil tabs
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Restricted Drug Restricted
GP - Amber
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Minoxidil is available for the treatment of hypertension resistant to other drugs.  
    • Tablet formulation only
 
Riociguat
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GP - Red
High Cost Medicine
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Approved for Pulmonary Arterial Hypertension in line with the NHSE Commissioning Policy (JFC May 2017)

Provider notes

  • NMUH:
    • Check for MHRA Drug Safety Updates
  • RFL:
    • Prior funding approval required
    • Approved for use by the pulmonary hypertension team
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NHSE 16055/P: Riociguat for pulmonary arterial hypertension
Selexipag
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Restricted Drug Restricted
GP - Red
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Prior funding approval required
    • Restricted to the treatment of pulmonary hypertension 
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NHSE 170104P: Selexipag for treating pulmonary arterial hypertension (adults)
Sildenafil
(Digital ulceration)
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Restricted Drug Restricted
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for digital ulceration in systemic sclerosis in line with NHSE Clinical Commissioning Policy A13/P/e (May 2015)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for use in digital ulcers as per NHSE policy
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Link  NHSE A13/P/e: Sildenafil and bosentan for the treatment of digital ulceration in systemic sclerosis
Sildenafil
(Pulmonary hypertension)
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Restricted Drug Restricted
GP - Red
NHS England
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for persistent pulmonary hypertension of the newborn (JFC May 2020).

Provider notes

  • NMUH:
    • Continuation only (not for initiation)  
  • RFL:
    • Prior funding approval required
    • For use by the pulmonary hypertension team only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NHSE A11/P/c: Targeted Therapies for use in Pulmonary Hypertension in Adults
Sodium nitroprusside
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Formulary
GP - Red
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Injection 50mg/5ml (unlicensed product)
 
Tadalafil
(Pulmonary hypertension)
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Restricted Drug Restricted
GP - Red
NHS England
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Prior funding approval required
    • Restricted to the treatment of pulmonary hypertension
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NHSE A11/P/c: Targeted Therapies for use in Pulmonary Hypertension in Adults
02.05.02  Centrally acting antihypertensive drugs
Clonidine
(Hypertension)
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Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Only 25 microgram tablets and the injection kept at the RFH
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Methyldopa
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Moxonidine
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Consultant Cardiologist use only
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
02.05.03  Adrenergic neurone blocking drugs to top
Guanethidine monosulfate
(Cardiology)
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
02.05.04  Alpha-adrenoceptor blocking drugs
Doxazosin
(Cardiology)
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Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Immediate release preparations only
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Immediate release preparations only.
    • Prolonged release preparations not recommended for routine use by NHSE (Dec 2017)
 
Prazosin
(Cardiovascular)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Only 500mcg and 1mg tablets stocked.
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
02.05.04  Phaeochromocytoma
Phenoxybenzamine hydrochloride
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Reserved for use in phaeochromocytoma only
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Reserved for use in phaeochromocytoma only
 
Phentolamine injection
(Phaeochromocytoma)
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Unlicensed Drug Unlicensed
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NOTE: There is more than one monograph for Phentolamine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
02.05.05  Drugs affecting the renin-angiotensin system
02.05.05  Heart Failure
Dapagliflozin tabs
(Heart failure)
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Restricted Drug Restricted
GP - Amber
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NICE TA for eligibility criteria

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • See NICE TA679
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA679: Dapagliflozin for treating chronic heart failure with reduced ejection fraction
02.05.05.01  Angiotensin-converting enzyme inhibitors (ACE inhibitors) to top
Captopril
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Only used for test dose
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • The use of Captopril is reserved for situations where a short- acting preparation is necessary.
 
Enalapril
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Lisinopril
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Perindopril Erbumine
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Ramipril
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Formulary
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Provider notes

  • NMUH:
    • Ramipril oral solution is NON-FORMULARY
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
02.05.05.02  Angiotensin-II receptor antagonists
Candesartan
(Cardiology)
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Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Restricted
  • UCLH:
  • WH:
    • 1st choice A2RA/ARB for heart failure
 
Irbesartan
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • 1st choice for hypertension / diabetes
 
Losartan
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Alternative (second-line) agent.
    • 25mg and 50mg tablets available only
 
Sacubitril + valsartan
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Restricted Drug Restricted
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To be used in line with NICE guidance only.

Provider notes

  • NMUH:
    • See NICE guidelines and NCL JFC position statement + GP Fact sheet
    • To be initiated under the direction of consultants with an established expertise in the management of heart failure - currently Dr Amal Muthmala and Dr Roger Rear
    • Note: There is an increased risk of severe angioedema with concomitant use of Angiotensin converting enzyme inhibitor (ACEi) with sacubitril. ACEi MUST BE STOPPED 36-48 hours prior to initiation of sacubitril/valsartan. If treatment with sacubitril/valsartan is stopped, ACEi therapy must NOT be initiated until 36 hours after the last dose of sacubitril/valsartan. For those taking an angiotensin II receptor blocker (ARB), sacubitril/valsartan can be started at the next scheduled dose of ARB.
  • RFL:
    • As per NCL position statement (see below)
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Restricted to use by consultant cardiologists only
    • NICE TA388 applies
 
Link  NCL JFC: Factsheet - Sacubitril valsartan (Entresto®) for chronic heart failure with reduced ejection fraction
Link  NCL JFC: Position statement - Sacubitril valsartan for heart failure (NEL and NCL joint positioning)
Link  NICE TA388: Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction
Valsartan
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Alternative (second-line) agent.
 
02.05.05.03  Renin inhibitors
02.06  Nitrates, calcium-channel blockers, and potassium-channel activators
02.06  Angina
02.06.01  Nitrates to top
Glyceryl trinitrate parenteral
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Glyceryl trinitrate short-acting (tablets and sprays)
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Formulary
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Provider notes

  • NMUH:
    • Nitrolingual Pumpspray and 500mcg sublingual tablets available
  • RFL:
    • Only 500 microgram tablets and 400 microgram spray kept at the RFH.
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Sublingual tablets 500 micrograms and 400 microgram spray available at WH
 
Glyceryl trinitrate transdermal
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Formulary
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Provider notes

  • NMUH:
    • Restricted to venous cannulation use only.
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Isosorbide dinitrate immediate released
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Isosorbide dinitrate parenteral
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to cardiac cath lab use only.
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • 0.1% infusion available only
 
Isosorbide mononitrate
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Formulary
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Provider notes

  • NMUH:
    • 60mg modified release and immediate release 10mg and 20mg tablets available
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • 60mg modified release and immediate release 10mg and 20mg tablets available
 
02.06.02  Calcium-channel blockers
Amlodipine
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Diltiazem immediate release
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Diltiazem modified release
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Formulary
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Prescribe by brand name: modified-release preparations have different release characteristics and are not interchangeable.

Provider notes

  • NMUH:
    • Adizem-SR, Adizem-XL, Tildiem LA, Tildiem Retard available
  • RFL:
    • Tildiem LA, Tildiem Retard and Slozem and the preferred brands
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Tildiem LA, Tildiem Retard available
 
Felodipine
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Nifedipine immediate release
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • 10mg capsules for autonomic dysreflexia in patients with a spinal cord injury above level of T6
  • UCLH:
  • WH:
    • No restriction stated
 
Nifedipine modified release
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Formulary
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Prescribe by brand name: modified-release preparations have different release characteristics and are not interchangeable.

Provider notes

  • NMUH:
    • Adalat Retard, Adalat LA, Coracten SR, Coracten XL available
  • RFL:
    • Adalat Retard, Adalat LA, Coracten SR and Coracten XL available
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Coracten SR and Coracten XL available
    • Adalat Retard (10mg and 20mg M/R tabs) discontinued
    • Adalat LA out of stock until further notice
 
Nimodipine
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted for subarachnoid haemorrhage only
  • RFL:
    • Restricted for subarachnoid haemorrhage only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Nimodipine is only available for use in ischaemic neurological deficits following subarachnoid haemorrhage.
 
Verapamil
(Cardiology)
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Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Verapamil injection restricted to cardiology
    • Both immediate release and M/R tablets stocked
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
02.06.03  Other anitanginal drugs
Nicorandil
(Angina)
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Restricted Drug Restricted
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Nicorandil should be reserved for second or third-line treatment of angina after failure or intolerance of beta-blockers or calcium antagonists.

Provider notes

  • NMUH:
    • Check for MHRA Drug Safety Updates
  • RFL:
    • See indication above
  • RNOH:
    • See restriction above
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Angina prescribing guideline
Ranolazine
(Angina)
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Restricted Drug Restricted
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For the symptomatic treatment of patients with stable angina as a fourth line option where beta-blocker and/or calcium channel blocker [1st and 2nd line] are ineffective or cannot be used; and where long-acting nitrate or nicorandil [3rd line options] are not effective.

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • See indication above
  • RNOH:
    • Required cardiologist approval. See restriction above.
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Angina prescribing guideline
Ivabradine
(Heart failure)
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Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NICE TA for eligibility criteria 

Secondary care notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary but may NOT be routinely stocked in pharmacy. This medicine will be ordered if use is as per local Trust Guideline or is approved by the Trust Medicines Management Committee. Contact pharmacy medicines information on ext 2417 for further information.
  • RFL:
    • Restricted to cardiology approval only - as per NICE TA
  • RNOH:
    • Requires CARDIOLOGIST approval
  • UCLH:
  • WH:
    • Available for prescribing to consultant cardiologists only
    • NICE TA267 applies
 
Link  NICE TA267: Ivabradine for treating chronic heart failure
02.06.04  Peripheral vasodilators and related drugs
Naftidrofuryl oxalate
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Formulary
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Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used  in line with NICE recommendations and/or Local Trust Guidelines.
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • NICE TA223 applies
 
Link  NICE TA223: Intermittent claudication drugs
Pentoxifylline
(Peripheral vascular disease)
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Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • NICE TA223 applies
 
Link  NICE TA223 (not recommended): Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease
02.06.04  Other preparations used in peripheral vascular disease
02.07  Sympathomimetics to top
02.07.01  Inotropic sympathomimetics
Dobutamine
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Dopamine
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Isoprenaline
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Unlicensed Drug Unlicensed
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Provider notes

  • NMUH:
    • For refractory bradycardia. Isoprenaline 2.25mg in 2ml injection, available from ‘special-order’ manufacturers or specialist importing companies
  • RFL:
    • Unlicensed product
    • Adhere to local protocols
  • RNOH:
    • Unlicensed product
    • Store in a refrigerator
  • UCLH:
  • WH:
    • Refractory bradycardia
    • Unlicensed product
 
02.07.02  Vasoconstrictor sympathomimetics
Ephedrine
(Hypotension)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted for use in Theatres only.
  • RFL:
    • No restriction stated
  • RNOH:
    • In idiopathic orthostatic hypotension in spinally injured patients
  • UCLH:
  • WH:
    • Ephedrine inj is available for use by anaesthetists only.
 
Metaraminol
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Unlicensed medicine. Available on a named patient basis only.
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Metaraminol inj is available for use by anaesthetists only
 
Midodrine
(Orthostatic Hypotension)
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Restricted Drug Restricted
GP - Amber
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for Orthostatic Hypotension for initiation in secondary care by specialist (e.g. Autonomic Unit) and transfer to primary care when stabilised (JFC July 2015)

Provider notes

  • NMUH:
    • To be used only on the recommendation of Consultants experienced in the management of severe orthostatic hypotension caused by autonomic dysfunction. Midodrine should only be used if non-pharmacological interventions, such as use of compression stockings, blood pressure monitoring, increased water and salt ingestion have failed. Midodrine is indicated for orthostatic hypotension due to autonomic dysfunction ONLY e.g. Parkinson's Disease, diabetic neuropathy. Use in other types of orthostatic hypotension is UNLICENSED. 
  • RFL:
    • Restricted for use as a second-line option for the treatment of symptomatic orthostatic hypotension
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted for use as a second-line option for the treatment of symptomatic orthostatic hypotension
 
Midodrine
(Dialysis induced hypotension)
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Formulary
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for dialysis induced hypotension (off-label). Prescribing to be retained in secondary care.

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to renal team for dialysis induced hypotension
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Noradrenaline
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Phenylephrine injection
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
02.07.03  Cardiopulmonary resuscitation
Adrenaline 1:10,000 (100 mcg/1 ml) injection
(Cardiopulmonary resuscitation; IV injection)
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
02.08  Anticoagulants and protamine
Idarucizumab
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Restricted Drug Restricted
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For dabigatran reversal. Restricted to patients with who have life/limb threatening bleeding, uncontrolled bleeding, or require emergency surgery (February 2016)

Provider notes

  • NMUH:
    • See Trust intranet for guideline
  • RFL:
    • As above
    • Haemophilia recommendation only
  • RNOH:
    • No restriction stated
  • UCLH:
    • Kept in blood transfusion lab and restricted to thrombosis haematology consultants only
  • WH:
    • Non-formulary
 
02.08.01  Parenteral anticoagulants to top
Argatroban
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Restricted Drug Restricted
GP - Red
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Anticoagulation in adult patients with heparin-induced thrombocytopenia (HIT) type II who require parenteral antithrombotic therapy and have renal failure (February 2013)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • As per restrictions above
    • Haemophilia recommendation only
  • RNOH:
    • Requires Haematologist approval. See restriction above.
  • UCLH:
    • Restricted to consultant haematologists. For patients with severe renal impairment (CrCl<30ml/min)
  • WH approval:
    • Non-formulary
 
02.08.01  Heparin
Heparin sodium
(Anticoagulation)
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Formulary
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

 

Provider notes

  • NMUH:
    • See links below
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NMUH: Trust Guideline on Management of Suspected and Confirmed Venous Thromboembolism in adult inpatients
Heparin calcium
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Formulary
GP - Red
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Provider notes

  • NMUH:
    • See links below
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NMUH: Trust Guideline on management of suspected and confirmed venousthromcoembolism in adult inpatients
02.08.01  Low molecular weight heparins
Enoxaparin
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Restricted Drug Restricted
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Red (hospital only prescribing) for defined course thromboprophylaxis and patients requiring treatment doses in line with NCL guidance (see Section 3.1)

Amber for long-term thromboprophylaxis and patients requiring treatment doses in line with NCL guidance (see Section 3.3)

 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Prophylaxis - only whilst tinzaparin shortage
    • Treatment - haemophilia recommendation only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC: Low molecular weight heparin use
Tinzaparin
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Formulary
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Red (hospital only prescribing) for defined course thromboprophylaxis and patients requiring treatment doses in line with NCL guidance (see Section 3.1)

Amber for long-term thromboprophylaxis and patients requiring treatment doses in line with NCL guidance (see Section 3.3)

 

Provider notes

  • NMUH:
    • Tinzaparin is FORMULARY when used for the treatment of suspected/confirmed DVT/PE & for Thromboprophylaxis.
    • See links below
  • RFL:
    • No restriction stated
  • RNOH:
    • As per local guidelines
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Low molecular weight heparin use
Link  NMUH: Letter to be sent to primary care when transferring patients on low molecular weight heparins (LMWH), where the supply and monitoring is to continue in primary care
Link  NMUH: Trust Guideline on Management of Suspected and Confirmed Venous Thromboembolism in Adult inpatients
02.08.01  Heparinoids
Danaparoid
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Restricted Drug Restricted
GP - Red
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • As per local protocol only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
02.08.01  Hirudins
Bivalirudin
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Restricted Drug Restricted
GP - Red
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Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary but may NOT be routinely stocked in pharmacy. This medicine will be ordered if use is as per local Trust Guideline or is approved by the Trust Medicines Management Committee. Contact pharmacy medicines information on ext 2417 for further information
  • RFL:
    • Non-formulary
  • RNOH:
    • Restricted
  • UCLH:
  • WH:
    • NICE TA230 applies. Not routinely stocked at WH.
 
Link  NICE TA230: Bivalirudin for the treatment of ST-segment-elevation myocardial infarction (STEMI)
02.08.01  Heparin flushes to top
Heparin sodium
(Flush - 10 units / mL)
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Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

 Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
  • UCLH:
  • WH:
    • No restriction stated
 
02.08.01  Epoprostenol
Epoprostenol
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Restricted Drug Restricted
GP - Red
High Cost Medicine
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Approved for 

Provider notes

  • NMUH:
    • Restricted for ICU use only.
    • Check MHRA for Drug Safety Updates
  • RFL:
    • Restricted to ITU and pulmonary hypertension
  • RNOH:
    • Non-formulary
  • UCLH:
    • Approved for primary pulmonary hypertension: functional grades III + IV
    • Approved for Inhibition of platelet aggregation during renal dialysis
  • WH approvals:
    • No restriction stated
 
Link  Nebulised iloprost or epoprostenol for COVID-19 associated ARDS Position Statement
02.08.01  Fondaparinux
Fondaparinux
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Restricted Drug Restricted
GP - Red
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Provider notes

  • NMUH:
    • Restricted to use for patients with Unstable Angina / NSTEMI.
    • See Trust Guideline on use
  • RFL:
    • Restricted to use for patients with Unstable Angina / NSTEMI
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Restricted for use in unstable angina and NSTMEI
 
02.08.02  Oral anticoagulants
Acenocoumarol
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted for patients allergic to Warfain only.
    • Check MHRA Drug Safety Updates
  • RFL:
    • Restricted for patients allergic to warfarin only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Apixaban tabs
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Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NICE TA for eligibity criteria

Rivaroxaban is the preferred DOAC for VTE, apixaban may be considered in line with NCL JFC Position Statement (JFC February 2020). 

Provider notes

  • NMUH:
    • Positive NICE TA This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • See JFC note above
    • Check MHRA Drug Safety Update
    • A referral form must be completed by Authorised Teams/ Haematology team to initiate a DOAC
    • A GP notification form must be completed and sent to the GP for each patient newly started on a DOAC
    • A copy of the above forms (referral form and GP notification form) must be sent to the anticoagulant clinic
  • RFL:
    • As per NICE guidance
    • Follow NCL DOAC prescribing guide
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • 2nd Choice DOAC - For Atrial Fibrillation / Stroke prevention.
 
Link  NCL JFC: Choice of DOAC for VTE - Position Statement
Link  NCL JFC: DOAC support documents (referral, counselling checklist, GP communication, prescribing support)
Link  NICE TA245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults
Link  NICE TA275: Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation
Link  NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
Apixaban tabs
(VTE prophylaxis in cancer)
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Restricted Drug Restricted
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for (JFC January 2019):

  • Multiple myeloma starting chemotherapy with thalidomide, lenalidomide or pomalidomide who would previously have received LMWH
  • Newly diagnosed multiple myeloma with additional VTE risk factor

Dose is 2.5mg twice-daily.

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for thromboprophylaxis for patients have thalidomide, lenalidomide, pomalidomide
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As above
 
Dabigatran caps
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Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NICE TA for eligibity criteria

Not preferred treatment for VTE (JFC February 2020; see Position Statement below).

Provider notes

  • NMUH:
    • As per NICE TA157, TA249, TA327 (not preferred)
    • Follow NCL DOAC prescribing guide
  • RFL:
    • As per NICE guidance
    • Follow NCL DOAC prescribing guide
  • RNOH:
    • Follow NCL DOAC prescribing guide
  • UCLH:
  • WH:
    • Restricted for use as thromboprophylaxis after elective hip and knee surgery
 
Link  NCL JFC: Choice of DOAC for VTE - Position Statement
Link  NCL JFC: DOAC support documents (referral, counselling checklist, GP communication, prescribing support)
Link  NICE TA157: Dabigatran etexilate for the prevention of venous thromboembolism (VTE) after hip or knee replacement surgery in adults
Link  NICE TA249: Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation
Link  NICE TA327: Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
Edoxaban tabs
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Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NICE TA for eligibility criteria

Not preferred treatment for VTE (JFC February 2020; see Position Statement below).

Provider notes

  • NMUH:
    • As per NICE TA354 (not preferred) and TA355
    • Follow NCL DOAC prescribing guide
  • RFL:
    • As per NICE guidance
    • Follow NCL DOAC prescribing guide
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Not to be used for initiation of therapy.
 
Link  NCL JFC: Choice of DOAC for VTE - Position Statement
Link  NCL JFC: DOAC support documents (referral, counselling checklist, GP communication, prescribing support)
Link  NICE TA354: Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism
Link  NICE TA355:Edoxaban for preventing stroke/systemic embolism in non‑valvular atrial fibrillation
Phenindione
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Should only be used in patients who are allergic to warfarin.
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Rivaroxaban tabs
(Hip/knee replacement; AF; VTE/PE; ACS; CAD or PAD)
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Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NICE TA for eligibility criteria

Preferred DOAC for treatment of VTE (JFC February 2020; see Position Statement below).

Provider notes

  • NMUH:
    • TA170, TA261 (preferred choice), TA265, TA287 (preferred choice), TA335
    • Follow NCL DOAC prescribing guide
  • RFL:
    • As per NICE guidance
    • Follow NCL DOAC prescribing guide
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • 1st Choice - For Atrial Fibrillation / Stroke prevention.
 
Link  NCL JFC: Choice of DOAC for VTE - Position Statement
Link  NCL JFC: DOAC support documents (referral, counselling checklist, GP communication, prescribing support, interactions)
Link  NCL JFC: Summary of antiplatelet options in cardiovascular disease
Link  NICE TA170: Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults
Link  NICE TA261: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
Link  NICE TA265: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
Link  NICE TA287: Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism
Link  NICE TA335: Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome
Link  NICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease
Link  NMUH: Risk Assessment Form for VTE for patients immobilised with lower limb casts
Link  NMUH: Rivaroxaban Information for Patients leaflet
Warfarin
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Formulary
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Provider notes

  • NMUH:No restriction stated
    • Check MHRA drug safety update
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
02.08.02  Stroke prevention in AF
02.08.02  VTE treatment to top
02.08.02  VTE prophylaxis in hip/knee surgery
02.08.03  Protamine sulphate
Protamine Sulphate
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • As per protocol only
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
02.09  Antiplatelet drugs
Aspirin
(Antiplatelet)
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Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • See NCL JFC summary of antiplatelet options in cardiovascular disease for specific indications
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Summary of antiplatelet options in cardiovascular disease
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
Cangrelor
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Restricted Drug Restricted
GP - Red
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Primary percutaneous coronary intervention (PPCI) who are intubated and cannot tolerate oral antiplatelets (JFC October 2017)
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Link  NICE TA351 (not recommended): Cangrelor for reducing atherothrombotic events in people undergoing percutaneous coronary intervention or awaiting surgery requiring interruption of anti‑platelet therapy (terminated appraisal)
Clopidogrel
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Formulary
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See NICE TA for eligibility

Provider notes

  • NMUH:
    • To be prescribed as per NICE guidelines - see links below for further details
  • RFL:
    • To be prescribed in line with NICE
    • See NCL summary for information on preferred choices for specific indications
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Summary of antiplatelet options in cardiovascular disease
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
Dipyridamole
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Formulary
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See NICE TA for eligibility

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used  in line with NICE recommendations and/or Local Trust Guidelines.
  • RFL:
    • See NCL JFC summary of antiplatelet options in cardiovascular disease for advice on specific indications
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Summary of antiplatelet options in cardiovascular disease
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
Eptifibatide
(Integrilin®)
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Prasugrel
(Acute coronary syndrome)
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Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NICE TA for eligibity.

Provider notes

  • NMUH:
    • Check for MHRA Drug Safety Updates
  • RFL:
    • In line with NICE guidance
    • See NCL JFC summary of antiplatelet options in cardiovascular disease for specific indications and alternatives
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • 10mg tablets available. Approved for stat dose (60mg) to be given to patients prior to transfer for PCI.
 
Link  NCL JFC: Summary of antiplatelet options in cardiovascular disease
Link  NICE TA317: Acute coronary syndrome - prasugrel
Prasugrel
(Intracranial stents)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved in combination with aspirin to minimise risk of thromboembolic complications in patients undergoing endovascular therapy of unruptured intracranial aneurysms (JFC March 2017)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Approved in combination with aspirin to minimise risk of thromboembolic complications in patients undergoing endovascular therapy of unruptured intracranial aneurysms (JFC Mar 2017).
 
Ticagrelor
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Restricted Drug Restricted
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See NICE TA for eligibity criteria

Provider notes

  • NMUH:
    • To be prescribed as per NICE guidelines - see links below for further details
  • RFL:
    • As per NICE guidance
    • See NCL JFC summary of antiplatelet options in cardiovascular disease for more information on agreed indications
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Summary of antiplatelet options in cardiovascular disease
Link  NICE TA236: Ticagrelor for the treatment of acute coronary syndromes
Link  NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction
Tirofiban
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Restricted Drug Restricted
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Approved following MI undergoing PCI in place of abciximab as GPI of choice (May 2015)

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Restricted to cardiology only.
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Tirofiban is available for prescribing at DMR level and above as per protocol for acute coronary syndrome
 
02.10  Stable angina, acute coronary syndromes, and fibrinolysis
02.10.01  Management of stable angina and acute coronary syndromes to top
02.10.02  Fibrinolytic drugs
Alteplase
(MI, PE, Ischaemic stroke)
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Restricted Drug Restricted
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Positive NICE TA This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • Restricted for use in Pulmonary Embolism (PE).
  • RFL:
    • Restricted to vascular surgery, MI and for use in the treatment of PE
  • RNOH:
    • Restricted
  • UCLH:
  • WH:
    • For massive PE and PE causing cardiac arrest
 
Link  NICE TA264: Ischaemic stroke (acute) - alteplase
Streptokinase
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Tenecteplase
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted for use in Myocardial Infarction
  • RFL:
    • Restricted to cardiology only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Urokinase
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Formulary
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Provider notes

  • NMUH:
    • Formulary for lysis of blood clots in thrombosed intravascular catheters and cannulae that are blocked by fibrin clots.
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Formulary for lysis of blood clots in thrombosed intravascular catheters and cannulae that are blocked by fibrin clots.
    • Urokinase 10,000 units strength available 
 
02.11  Antifibrinolytic drugs and haemostatics
Tranexamic Acid
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Emicizumab
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for congenital haemophilia A with factor VIII inhibitors in line with NHSE clinical commissioning policy 170067/P (RFL only; JFC November 2018)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NHSE 170067/P: Emicizumab as prophylaxis in people with congenital haemophilia A with factor VIII inhibitors (all ages)
02.11  Blood-related products
Antithrombin III
(Kybemin®)
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Restricted Drug Restricted
High Cost Medicine
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Available through the haemophilia centre
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Factor IX
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Restricted Drug Restricted
High Cost Medicine
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Available from the haemophilia centre
    • Alphanine®, Alprolix® (eftrenonacog alfa), Benefix® (nonacog alfa), Idelvion® (albutrepenonacog alfa), Refixia® (nonacog beta pegol)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Factor VIIa, recombinant
(Novo 7®)
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Restricted Drug Restricted
High Cost Medicine
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Available from the haemophilia centre
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Factor VIII
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Restricted Drug Restricted
High Cost Medicine
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Provider notes

  • NMUH:
    • PbR (Payment by Results) excluded drug
  • RFL:
    • Available from the Haemophilia centre
    • Advate® (octocog alfa), Elocta® (efmoroctocog alfa), Fanhdi®, Fibrogammin®, Helixate Nexgen® (octocog alfa), Kogenate® (octocog alfa), Novoeight®, Optivate®, Refacto AF® (moroctocog alfa)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Factor VIII + von Willebrand factor
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Available through the haemophilia centre
    • Voncento®, Wilate®, Haemate P®
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Factor VIII Inhibitor Bypassing Fraction
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Restricted Drug Restricted
High Cost Medicine
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Available through the haemophilia centre
    • Feiba®
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Factor VIII, recombinant
(Susoctocog alfa; Obizur®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for acquired haemophilia A in line with NHSE clinical commissioning policy 170061P (RFL only; JFC November 2018)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NHSE 170061P: Susoctocog alfa for treating bleeding episodes in people with acquired haemophilia A (all ages)
Factor X (Coagadex®)
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Restricted Drug Restricted
High Cost Medicine
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Available from the haemphilia centre
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Factor XIII Fraction, Dried
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Restricted Drug Restricted
High Cost Medicine
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Available from the haemophilia centre
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Human fibrinogen
(Riastap®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
High Cost Medicine
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Available through the haemophilia centre
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Prothrombin Complex Concentrate
(Octaplex®)
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Restricted Drug Restricted
High Cost Medicine
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Provider notes

  • NMUH:
    • PbR (Payment by Results) excluded drug. For rapid reversal of anticoagulation in life-threatening bleeding due to oral anticoagulation. To be administered with 5mg of intravenous vitamin K.
  • RFL:
    • Available from the haemophilia centre.
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
von Willebrand factor
(Willfact®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Available from the haemophilia centre
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Factor XI (Hemoleven®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
High Cost Medicine
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Available from the Haemphilia centre
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
02.12  Lipid-regulating drugs
Alirocumab
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Restricted Drug Restricted
GP - Red
High Cost Medicine
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Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • To be prescribed on the recommendation of Consultant Cardiologists and Endocrinologists ONLY
    • See links below
  • RFL:
    • As per NICE guidance
    • Restricted to Lipid Clinic
    • Prescriptions are supplied monthly for first 4 months then 3 monthly.  Homecare service also available
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • As per NICE TA
 
Link  NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
Evolocumab
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Restricted Drug Restricted
GP - Red
High Cost Medicine
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Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • To be prescribed on the recommendation of Consultant Cardiologists and Endocrinologists ONLY
    • See links below
  • RFL:
    • As per NICE guidance
    • Restricted to Lipid Clinic
    • Prescriptions are supplied monthly for first 4 months then 3 monthly.  Homecare service also available
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
02.12  Bile acid sequestrants to top
Colestyramine
(Hypercholesterolaemia)
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Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Sugar-free formulation preferred
    • Restricted to Lipid Clinid for hypercholesterolaemia 
    • Current shortage - colestipol is the recommended alternative
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC (not routinely recommended): Statin Prescribing & Lipid Modification Guideline for the Prevention of Cardiovascular Disease
Colestipol (Colestid®)
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to Lipid clinic for hypercholesterolaemia 
    • Restricted to Hepatology / Gastroenterology for partial biliary obstruction, primary biliary cirrhosis and diarrhoea if colestyramine is unavailable (off-label)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC (not routinely recommended): Statin Prescribing & Lipid Modification Guideline for the Prevention of Cardiovascular Disease
Colesevelam
(Cholestagel®)
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary for hypercholesterolaemia 
    • Available for partial biliary obstruction, primary biliary cirrhosis and diarrhoea if colestyramine and colestipol is unavailable (off-label)
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC (not routinely recommended): Statin Prescribing & Lipid Modification Guideline for the Prevention of Cardiovascular Disease
02.12  Ezetimibe
Ezetimibe
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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Primary hypercholesterolaemia where a statin is contraindicated, not tolerated (consider referral to lipid specialist) or as an adjunct where high-intensity statins have failed to sufficiently reduce cholesterol levels

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • See links below
  • RFL:
    • See indication above and NICE TA
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • The use of ezetimibe is reserved as a 3rd line agent where treatment with simvastatin, and then atorvastatin has failed, and for patients for whom the use of a statin is contraindicated, or who are statin intolerant, in accordance with the NICE guidance.
 
Link  NCL JFC: Statin Prescribing & Lipid Modification Guideline
Link  NICE TA385: Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia
02.12  Fibrates
Bezafibrate
(Hypertriglyceridaemia, Mixed hyperlipidaemia)
View adult BNF View SPC online View childrens BNF
Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Immediate and modified release
    • No restriction stated
  • RFL:
    • Immediate and modified release
    • Restricted to Lipid Clinic
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC (not routinely recommended): Statin Prescribing & Lipid Modification Guideline for the Prevention of Cardiovascular Disease
Ciprofibrate
View adult BNF View SPC online View childrens BNF
Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to Lipid Clinic
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC (not routinely recommended): Statin Prescribing & Lipid Modification Guideline for the Prevention of Cardiovascular Disease
Fenofibrate
View adult BNF View SPC online View childrens BNF
Formulary
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Provider notes

  • NMUH:
    • Lipantil stocked
  • RFL:
    • Restricted to Lipid Clinic
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • 160mg tablets only
 
Link  NCL JFC (not routinely recommended): Statin Prescribing & Lipid Modification Guideline for the Prevention of Cardiovascular Disease
02.12  Statins
Atorvastatin
View adult BNF View SPC online View childrens BNF
Formulary
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Provider notes

  • NMUH:
    • See NCL JFC Statins Guideline
  • RFL:
    • No restriction stated 
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Statin Prescribing & Lipid Modification Guideline
Pravastatin
View adult BNF View SPC online View childrens BNF
Formulary
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Provider notes

  • NMUH:
    • See NCL JFC Statins Guideline
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Statin Prescribing & Lipid Modification Guideline
Rosuvastatin
View adult BNF View SPC online View childrens BNF
Formulary
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Provider notes

  • NMUH:
    • See NCL JFC Statins Guideline
  • RFL:
    • As per NCL JFC statin guideline
  • RNOH:
    • As per NCL JFC statin guideline
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC: Statin Prescribing & Lipid Modification Guideline
Simvastatin
View adult BNF View SPC online View childrens BNF
Formulary
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Provider notes

  • NMUH:
    • See NCL JFC Statins Guideline
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Statin Prescribing & Lipid Modification Guideline
02.12  Nicotinic acid group
02.12  Omega-3 fatty acid compounds to top
Omega-3-Acid Ethyl Esters
(Omacor®)
(Hypertriglyceridaemia )
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for the management of inherited hypertriglyceridaemia (type 3 hyperlipidaemia, lipoprotein lipase deficiency or in presence of raised chylomicrons and VLDL), when triglycerides levels are ≥10mmol/L despite addressing secondary causes, uptake of lifestyle changes and pharmacological therapy (JFC January 2019). Additional information: Daily dose 2-6g; high dose increases the risk of gastrointestinal adverse effects.

See guideline below

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted lipid clinic patients only (see indication above)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Initiation by lipid clinic only
 
Link  NCL JFC: Guidance for the management of hypertriglyceridaemia
Link  NCL JFC: Guidance for the review of Omega-3 fatty acids
Link  NCL JFC: Position statement for omega-3 fatty acids
02.13  Local sclerosants
Sodium Tetradecyl Sulphate
(Fibro-Vein®)
View childrens BNF
Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • 0.2%, 0.5%, 1% and 3% stocked
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
02.14  Unlicensed Medicines / Significant off-label use
Alteplase
(Catheter Directed Thrombolysis (CDT))
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
    • Any suitable patients to be referred to RFH as per guidelines
  • RFL:
    • Approved for:
      • Iliofemoral DVT with (i) May-Thurner syndrome OR extensive clots AND (ii) who have severe symptoms despite 5-7 days anticoagulation OR where a limb is threatened (JFC July 2018)
      • Paget-Schroetter Syndrome
    • Not approved for:
      • Massive or high risk PE (defined as acute PE with sustained hypotension [SBP ≤ 90 mm Hg for at least 15 min or requiring inotropic support, not due to a cause other than PE, such as arrhythmia, hypovolemia, sepsis, or LV dysfunction], pulselessness or persistent profound bradycardia [pulse < 40 bpm], with signs or symptoms of shock) (JFC July 2018)
  • RNOH:
    • Non-formulary
  • UCLH:
    • Approved for:
      • Iliofemoral DVT with (i) May-Thurner syndrome OR extensive clots AND (ii) who have severe symptoms despite 5-7 days anticoagulation OR where a limb is threatened (UMC June 2018)
      • Upper Limb Central Venous Catheter (CVC) Related Thrombosis as last-line therapy (UMC June 2018)
    • Not approved for:
      • Paget-Schroetter Syndrome- Refer patient to RFH (UMC June 2018)
      • Stent rethrombosis (UMC June 2018)
      • Massive or high risk PE (defined as acute PE with sustained hypotension [SBP ≤ 90 mm Hg for at least 15 min or requiring inotropic support, not due to a cause other than PE, such as arrhythmia, hypovolemia, sepsis, or LV dysfunction], pulselessness or persistent profound bradycardia [pulse < 40 bpm], with signs or symptoms of shock) (UMC June 2018)
  • WH:
    • Non-formulary
 
Celiprolol
(vascular Ehlers-Danlos syndrome)
View adult BNF View SPC online View childrens BNF
Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for vascular Ehlers-Danlos syndrome (JFC April 2016)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Ajmaline
(Brugada syndrome)
View childrens BNF
Unlicensed Drug Unlicensed
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Provider notes

  • NMUH:
    • Restricted to Consultant Cardiologists ONLY.
    • Ajmaline 50mg in 10mL injection - available from 'special-order' manufacturers or specialist importing companies.
    • See Trust guideline via intranet
  • RFL:
    • Approve for diagnosis of Brugada syndrome (August 2016)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Chlorothiazide
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
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Provider notes

  • NMUH:
    • For the treatment of chronic hypoglycaemia, heart failure, hypertension and ascites, in children.
    • See the BNF for children for further prescribing information.
    • Chlorothiazide suspension 250mg/5ml, available from ‘special-order’ manufacturers or specialist importing companies
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Chlorothiazide Suspension 250 mg/5 ml (unlicensed product)
 
Levosimendan infusion
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
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Approved for patients not responding to, or intolerant of, conventional inotropes if they have a reasonable expectation of survival and one of the below:

  • Acute decompensation of severe chronic heart failure [NYHA III/IV].
  • Low cardiac output syndrome.
  • Takotsubo cardiomyopathy (JFC August 2020).

Provider notes

  • NMUH:
    • Restricted to ITU only for indications above. Follow local guidance.
  • RFL:
    • Second line option after use of Dobutamine and Milrinone, for the indications above in line with NCL JFC. Follow local guidance.
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • As above

 

 
Quinidine
(Brugada Syndrome)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
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Approved for Brugada Syndrome (RFL only; JFC February 2018).

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for Brugada Syndrome 
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
 ....
 Non Formulary Items
Abciximab

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Non Formulary
Acebutolol

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Non Formulary
Acipimox

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Non Formulary
Adenosine 30 mg/10mL injection
(Adenoscan®)

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Non Formulary
Aliskiren

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Non Formulary
Amiloride + Cyclopenthiazide

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Non Formulary
Amlodipine + Valsartan

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Non Formulary
Andexanet

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Non Formulary

Not approved for reversal of DOAC related bleeds (JFC August 2019).

Apixaban tabs
(Antiphospholipid syndrome)

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Non Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Not recommended for the prevention of thromboembolic events in patients with antiphospholipid syndrome (JFC July 2019)

Aprotinin (Trasylol®)

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Non Formulary
Atenolol + Co-amilozide

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Non Formulary
Atenolol + Nifedipine

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Non Formulary
Atorvastatin and Ezetimibe
(Atozet®)

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Non Formulary
Azilsartan

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Non Formulary
Bumetanide + Amiloride

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Non Formulary
Captopril + Hydrochlorothiazide
(Co-zidocapt®)

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Non Formulary
Catridecacog
(NovoThirteen®)

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Non Formulary
High Cost Medicine
Celiprolol
(Cardiology)

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Non Formulary

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Chlortalidone

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Non Formulary
Cilazapril (Vascace®)

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Non Formulary
Cilostazol

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Non Formulary
Link  NICE TA223 (not recommended): Intermittent claudication drugs
Co-flumactone
(Spironolactone + Hydroflumethiazide)

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Non Formulary
Co-triamterzide
(Hydrochlorothiazide + Triamterene)

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Non Formulary
Cyclopenthiazide

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Non Formulary
Dabigatran caps
(Antiphospholipid syndrome)

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Non Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Not recommended for the prevention of thromboembolic events in patients with antiphospholipid syndrome (JFC July 2019)

Dalteparin

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Non Formulary

Red (hospital only prescribing) for defined course thromboprophylaxis and patients requiring treatment doses in line with NCL guidance (see Section 3.1)

Amber for long-term thromboprophylaxis and patients requiring treatment doses in line with NCL guidance (see Section 3.3)

Link  NCL JFC: Low molecular weight heparin use
Dipyridamole + Aspirin

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Non Formulary
Dopexamine

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Non Formulary
Doxazosin modified release
(Cardiology)

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Non Formulary
Drotrecogin alfa
(Xigris®)

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Non Formulary
Edoxaban tabs
(Antiphospholipid syndrome)

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Non Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Not recommended for the prevention of thromboembolic events in patients with antiphospholipid syndrome (JFC July 2019)

Enalapril + Hydrochlorothiazide
(Innozide®)

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Non Formulary
Eprosartan

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Non Formulary
Etamsylate

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Non Formulary
Ethanolamine Oleate

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Non Formulary
Flecainide acetate modified release

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Non Formulary
Fluvastatin immediate release

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Non Formulary
Link  NCL JFC: Statin Prescribing & Lipid Modification Guideline
Fluvastatin modified release

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Non Formulary
Link  NCL JFC: Statin Prescribing & Lipid Modification Guideline
Fosinopril

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Non Formulary
Furosemide + Spironolactone

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Non Formulary
Gemfibrozil

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Non Formulary
Link  NCL JFC (not routinely recommended): Statin Prescribing & Lipid Modification Guideline for the Prevention of Cardiovascular Disease
Hydrochlorthiazide

View childrens BNF
Unlicensed Drug Unlicensed
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Not approved for hyperkalaemic periodic paralysis after failure of bendoflumethiazide (June 2017)

Imidapril

View adult BNF View SPC online View childrens BNF
Non Formulary
Indoramin
(Cardiology)

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Non Formulary

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Inositol Nicotinate

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Non Formulary
Link  NICE TA223 (not recommended): Intermittent claudication drugs
Irbesartan + hydrochlorothiazide

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Non Formulary
Isosorbide dinitrate modified release

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Non Formulary
Isradipine

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Non Formulary
Ivabradine
(Angina)

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Non Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Not approved for stable angina (November 2014)

Lacidipine

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Non Formulary
Lercanidipine

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Non Formulary
Lisinopril + Hydrochlorothiazide

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Non Formulary
Lomitapide

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Non Formulary
High Cost Medicine
Losartan + hydrochlorothiazide

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Non Formulary
Mexiletine caps
(Cardiac)

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Non Formulary
GP - Red

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

 Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
Mexiletine caps
(Myotonia)

View adult BNF View SPC online View childrens BNF
Non Formulary
GP - Red

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

 Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
Moexipril

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Non Formulary
Moracizine

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Non Formulary
Moxisylyte

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Non Formulary
Nadolol

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Non Formulary
Nicardipine

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Non Formulary
Olmesartan

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Non Formulary
Olmesartan + amlodipine besilate

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Non Formulary
Olmesartan + amlodipine besilate + hydrochlorothiazide

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Non Formulary
Olmesartan + hydrochlorothiazide

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Non Formulary
Omega-3-Acid Ethyl Esters
(Omacor®)
(Cardiovascular, NASH, sleep problems, Familial hypercholesterolemia, Multiple sclerosis)

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Non Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Not recommended for (JFC January 2019):

  • Primary and secondary prevention of cardiovascular disease
  • Secondary prevention of MI
  • Non-alcoholic fatty liver disease
  • Management of sleep problems in children and young people associated with autism
  • Familial hypercholesterolemia
  • Multiple sclerosis
Link  NCL JFC (not routinely recommended): Statin Prescribing & Lipid Modification Guideline for the Prevention of Cardiovascular Disease
Oxerutins (Paroven®)

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Non Formulary
Oxprenolol hydrochloride

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Non Formulary
Oxprenolol hydrochloride + Cyclopenthiazide

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Non Formulary
Oxprenolol hydrochloride modified release

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Non Formulary
Perindopril Arginine
(Coversyl® Arginine)

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Non Formulary
Perindopril Arginine + indapamide
(Coversyl® Arginine Plus)

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Non Formulary
Pindolol

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Non Formulary
Pindolol + Clopamide

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Non Formulary
Procainamide

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Non Formulary
Protein C Concentrate
(Ceprotin®)

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Non Formulary
High Cost Medicine
Quinapril

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Non Formulary
Quinapril + Hydrochlorothiazide

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Non Formulary
Ramipril + Felodipine

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Non Formulary
Rasitro ®

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Non Formulary
Reteplase

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Non Formulary
Rivaroxaban tabs
(VTE prophylaxis in cancer; Antiphospholipid syndrome)

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Non Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Not recommended for thromboprophylaxis during neo-adjuvant chemotherapy prior to elective interval debulking surgery or stage III & IV primary epithelial ovarian cancer (JFC October 2018)

Not recommended for the prevention of thromboembolic events in patients with antiphospholipid syndrome (JFC July 2019)

Sevikar HCT ®

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Non Formulary
Simoctocog alfa (Nuwiq®)

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Non Formulary
Simvastatin and Ezetimibe
(Inegy®)

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Non Formulary
Telmisartan

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Non Formulary
Telmisartan + hydrochlorothiazide

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Non Formulary
Terazosin
(Hypertension)

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Non Formulary
Timolol

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Non Formulary
Timolol maleate + Bendroflumethiazide

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Non Formulary
Timolol maleate + Co-amilozide

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Non Formulary
Tolazoline

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Non Formulary
Torasemide

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Non Formulary
Trandolapril

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Non Formulary
Trandolapril + Verapamil

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Non Formulary
Treprostinil

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Unlicensed Drug Unlicensed
GP - Red
Triamterene

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Non Formulary
Triamterene + Chlortalidone

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Non Formulary
Triamterene + Furosemide

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Non Formulary
Valsartan + hydrochlorothiazide

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Non Formulary
Vernakalant

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Non Formulary
GP - Red
Vorapaxar (Zontivity®)

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Non Formulary
Xipamide

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Non Formulary
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Homecare
Homecare

Traffic Light Status Information

Status Description

GP - Amber

Medicines that should be initiated by a specialist. Prescribing can be transferred to primary care once the patient has been stabilised.  

Shared care: For drugs with regular, ongoing need for monitoring and/or assessment of efficacy or toxicity. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the North Central London JFC.

Fact sheet: For drugs with some concerns surrounding safety or efficacy but do not require regular monitoring and/or monitoring of effectiveness/toxicity.

  

GP - Red

Medicines which should normally be prescribed by specialists only (hospital only).

For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.

See link for the complete NCL Red List https://www.ncl-mon.nhs.uk/wp-content/uploads/2017/08/ncl_red_list.pdf

  

Black

Medicines not recommended for routine use in primary or secondary care.

Medicines, which the North Central London JFC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.

  

netFormulary