North Central London Formulary


	North Central London Joint Formulary

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Formulary Chapter 2: Cardiovascular system - Full Chapter

02.08.01

Parenteral anticoagulants

Argatroban

Restricted

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)

Formulary

Provider notes

NMUH:
- See links below
RFL:
- No restriction stated
RNOH:
- No restriction stated
UCLH:
WH:
- No restriction stated

NMUH: Trust Guideline on Management of Suspected and Confirmed Venous Thromboembolism in adult inpatients

Heparin calcium

Formulary

Provider notes

NMUH:
- See links below
RFL:
- No restriction stated
RNOH:
- Non-formulary
UCLH:
WH:
- Non-formulary

NMUH: Trust Guideline on management of suspected and confirmed venousthromcoembolism in adult inpatients

02.08.01

Low molecular weight heparins

Enoxaparin

Restricted

Provider notes

NMUH:
- Non-formulary
RFL:
- Prophylaxis - only whilst tinzaparin shortage
- Treatment - haemophilia recommendation only
RNOH:
- Non-formulary
UCLH:
WH:
- Non-formulary

Tinzaparin

Formulary

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

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

NMUH: Trust Guideline on Management of Suspected and Confirmed Venous Thromboembolism in Adult inpatients

02.08.01

Heparinoids

Danaparoid

Restricted

Provider notes

NMUH:
- Non-formulary
RFL:
- As per local protocol only
RNOH:
- Non-formulary
UCLH:
WH:
- Non-formulary

02.08.01

Hirudins

Bivalirudin

Restricted

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.

NICE TA230: Bivalirudin for the treatment of ST-segment-elevation myocardial infarction (STEMI)

02.08.01

Heparin flushes

Heparin sodium flush (10 units / mL)

Formulary

Provider notes

NMUH:
- No restriction stated
RFL:
- No restriction stated
RNOH:
UCLH:
WH:
- No restriction stated

02.08.01

Epoprostenol

Restricted

Approved for pulmonary hypertension (November 2013)

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

02.08.01

Fondaparinux

Restricted

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

....

Non Formulary Items

Dalteparin

Non Formulary

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs

	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

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