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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.08.02  Expand sub section  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  Expand sub section  Stroke prevention in AF
02.08.02  Expand sub section  VTE treatment
02.08.02  Expand sub section  VTE prophylaxis in hip/knee surgery
 ....
 Non Formulary Items
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)

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)

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)

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)

  
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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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