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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.05.05.02  Expand sub section  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
GP - Amber
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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 (EntrestoŽ) 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.
 
 ....
 Non Formulary Items
Azilsartan

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Non Formulary
Eprosartan

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Non Formulary
Irbesartan + hydrochlorothiazide

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Non Formulary
Losartan + hydrochlorothiazide

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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
Telmisartan

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Non Formulary
Telmisartan + hydrochlorothiazide

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Non Formulary
Valsartan + hydrochlorothiazide

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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
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Link to adult BNF
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Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Homecare
Homecare

Traffic Light Status Information

Status Description

GP - 1st

Medicines suitable for first-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

GP - 2nd

Medicines suitable for second-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

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

  

GP - Grey

Medicines on hospital formularies which have not been reviewed for suitability in primary care.  

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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