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North Central London
Joint Formulary
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.12  Expand sub section  Lipid-regulating drugs
Alirocumab
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Restricted Drug Restricted
GP - Red
High Cost Medicine

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 TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
Evolocumab
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Restricted Drug Restricted
GP - Red
High Cost Medicine

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  Expand sub section  Bile acid sequestrants
Colestyramine
(Hypercholesterolaemia)
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Formulary

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
    • As a precautionary measure, where concurrent drug therapy exists then such drugs should be administered at least one hour before or 4-6 hours after colestyramine.
  • 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

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)
    • Patients should take other drugs at least 1 hour before or 4 hours after colestipol to minimise possible interference with their absorption
  • 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

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)
    • Cholestagel should be administered at least 4 hours before or at least 4 hours after the concomitant medication in order to minimize the risk of reduced absorption of the concomitant medication
  • 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  Expand sub section  Ezetimibe
Ezetimibe
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Restricted Drug Restricted

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  Expand sub section  Fibrates
Bezafibrate
(Hypertriglyceridaemia, Mixed hyperlipidaemia)
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Formulary

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
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Formulary

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
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Formulary

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  Expand sub section  Statins to top
Atorvastatin
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Formulary

Provider notes

  • NMUH:
    • See NCL JFC Statins Guideline
  • RFL:
    • No restriction stated 
  • RNOH:
    • Restricted
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Statin Prescribing & Lipid Modification Guideline
   
Fluvastatin
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Restricted Drug Restricted

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to liver and renal patients only.
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC: Statin Prescribing & Lipid Modification Guideline
   
Pravastatin
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Formulary

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
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Formulary

Provider notes

  • NMUH:
    • See NCL JFC Statins Guideline
  • RFL:
    • As per NCL guideline below
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC: Statin Prescribing & Lipid Modification Guideline
   
Simvastatin
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Formulary

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  Expand sub section  Nicotinic acid group
02.12  Expand sub section  Omega-3 fatty acid compounds
Omega-3-Acid Ethyl Esters (Omacor)
(Hypertriglyceridaemia )
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Restricted Drug Restricted

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
   
 ....
 Non Formulary Items
Acipimox

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Non Formulary
 
Atorvastatin and Ezetimibe  (Atozet)

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Non Formulary
 
Fluvastatin modified release

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

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

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

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Non Formulary
Black

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
 
Simvastatin and Ezetimibe  (Inegy)

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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
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

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.

  

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.

  

netFormulary