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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.05.01  Expand sub section  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
(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
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
Hydralazine
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Formulary
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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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Restricted Drug Restricted
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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Restricted Drug Restricted
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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Restricted Drug Restricted
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
(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
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
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
 ....
 Non Formulary Items
Tolazoline

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Non Formulary
Treprostinil

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Unlicensed Drug Unlicensed
GP - Red
  
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
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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.

  

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