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Bedfordshire and Luton Joint Formulary
Bedford Hospital NHS Trust
Bedfordshire CCG
Luton & Dunstable University Hospital NHS Foundation Trust
Luton CCG
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing

 Details...
02.01  Positive inotropic drugs
02.01.01  Cardiac glycosides
Digoxin
(Injection)
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Formulary
Red

500mcg in 2mL 100micrograms in 1mL - for paediatric use only.

Approximate bioavailability equivalences: 75microgram IV : 100microgram elixir : 125mcg tablet

 
   
Digoxin  62.5, 125, & 250micrograms
(Tablets)
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Formulary
Green

Approximate bioavailability equivalences:
75microgram IV :  100microgram elixir : 125mcg tablet

 
   
Digoxin 50micrograms in 1mL
(Elixir)
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Formulary
Green

Approximate bioavailability equivalences:
75microgram IV :  100microgram elixir : 125mcg tablet

 
   
02.01.01  Digoxin-specific antibody
Digoxin specific antibody fragments (Digifab®)
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Restricted Drug Restricted
Red
High Cost Medicine
Consult ToxBase for dosing and administration
Seek specialist advice before initiating treatment
Available in the Emergency Drug Cupboard via 555 bleep holder
Intravenous infusion only
40mg vials

 
Link  Toxbase
   
02.01.02  Phosphodiesterase type-3 inhibitors
Milrinone (Primacor®)
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Restricted Drug Restricted
Red
For use in ITU, NICU & SCBU only
10mg in 10mL injection

 
   
02.02  Diuretics to top
02.02.01  Thiazides and related diuretics
Indapamide
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First Choice
Green
1st choice Thiazide diuretic in the treatment of hypertension
2.5mg Tablets
1.5mg Modified-Release Tablets
 
Bendroflumethiazide
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Formulary
Green
2.5mg Tablets 
   
Metolazone
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Formulary
Amber
5mg Tablets 
   
02.02.02  Loop diuretics
Furosemide 20mg, 40mg & 500mg
(Tablets)
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First Choice
Green



 
Bumetanide
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Second Choice
Green
1mg & 5mg Tablets 
   
Furosemide
(Injection)
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Formulary
Red

20mg in 2mL

50mg in 5mL

250mg in 25mL

 
   
Furosemide
(Oral solution)
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Formulary
Green

20mg in 5mL

40mg in 5mL

 
   
02.02.03  Potassium-sparing diuretics and aldosterone antagonists
Amiloride Hydrochloride
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Formulary
Green
5mg Tablets
5mg in 5mL Sugar-Free Liquid 
   
02.02.03  Aldosterone antagonists
Spironolactone 25mg, 50mg & 100mg
(Tablets)
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Formulary
Green
 
   
Eplerenone
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Formulary
Amber

25mg & 50mg Film-Coated Tablets

For 2nd-line use after spironolactone.

 
Link  NICE CG108: Chronic heart failure
   
Spironolactone 50mg in 5mL
( Sugar-Free Suspension)
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Restricted Drug Restricted
Green

Only use if tablets unsuitable. N.B. tablets can be crushed and mixed with water for enteral feeding tube administration.

Standard strength liquid is 50mg/5ml as per RCPCH/NPPG guidance - RCPCH/NPPG Standardised strengths of unlicensed liquids

 
   
02.02.04  Potassium-sparing diuretics with other diuretics to top
Co-amilofruse
(Furosemide and Amiloride)
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Formulary
Green
2.5/20mg Tablets
5/40mg Tablets 
   
02.02.05  Osmotic diuretics
Mannitol
(Polyfusor)
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Formulary
Red
10% & 20% 500ml Polyfusor - intravenous infusion 
   
02.02.06  Mercurial diuretics
02.02.07  Carbonic anhydrase inhibitors
02.02.08  Diuretics with potassium
02.03  Anti-arrhythmic drugs to top
02.03.01  Management of arrhythmias
02.03.02  Drugs for arrhythmias
 note 

Add a subsection note..

02.03.02  Supraventricular arrhythmias
Adenosine (Adenocor®)
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Formulary
Red
Seek specialist Cardiology input
6mg in 2mL Injection
30mg in 10mL Injection
unlicensedunlicensed 120mg in 120mL - Cardiac Centre only 
   
Dronedarone (Multaq®)
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Restricted Drug Restricted
Red

Only to be initiated and monitored under specialist supervision by a Consultant Cardiologist in line with NICE TA197
400mg Tablets

 
Link  NICE TA197: Atrial fibrillation - dronedarone
   
02.03.02  Supraventricular and ventricular arrhythmias
Amiodarone
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Formulary
Amber

100mg & 200mg Tablets
L&D Hospital: If newly prescribing oral treatment, ensure loading regime is prescribed using ePMA protocol.

 
   
Amiodarone
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Formulary
Red
150mg in 3mL Injection
300mg in 10mL Pre-filled syringe 
   
Disopyramide
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Formulary
Amber
100mg Capsules 
   
Flecainide
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Formulary
Amber
50mg & 100mg Tablets
 
   
Propafenone 150mg, 300mg
(Tablets)
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Formulary
Red
 
   
Flecainide 150mg in 15mL
( Injection)
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Formulary
Red

unlicensed  Unlicensed

Stocked in the L&D EDC.

Licensed product was discontinued

 
   
02.03.02  Ventricular arrhythmias to top
Lidocaine
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Formulary
Red
1% in 5mL, 10mL & 20mL Vial
2% in 5mL Vial
 
   
02.04  Beta-adrenoceptor blocking drugs
Atenolol
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Formulary
Green
25mg, 50mg & 100mg Tablets
25mg in 5mL Sugar-Free Solution
 
   
Atenolol
(Injection)
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Formulary
Red
5mg in 10mL Injection 
   
Bisoprolol
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Formulary
Green
1.25mg, 2.5mg, 5mg, 7.5mg & 10mg Tablets 
   
Carvedilol
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Formulary
Green
3.125mg, 6.25mg, 12.5mg & 25mg Tablets 
   
Esmolol
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Formulary
Red
100mg in 10mL Injection 
   
Labetalol
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Formulary
Green
50mg, 100mg & 200mg Tablets
 
Link  NICE CG107: Hypertension in pregnancy: diagnosis and management
   
Labetalol
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Formulary
Red
100mg in 20mL Injection 
   
Metoprolol
(Injection)
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Formulary
Red
5mg in 5mL Injection 
   
Metoprolol
(Tablets)
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Formulary
Green
50mg Tablets
Tablets can be halved
 
   
Propranolol
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Formulary
Green
10mg, 40mg & 80mg tablets
80mg MR capsules
10mg in 5mL sugar-Free Solution
50mg in 5mL sugar-Free Solution

 
   
Sotalol
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Formulary
Amber
40mg & 80mg Tablets
Non-cardioselective beta-blocker with additional class III anti-arrhythmic activity used for prophylaxis in paroxysmal supraventricular arrhythmias. 
   
02.05  Drugs affecting the renin-angiotensin system and some other antihypertensive drugs
02.05.01  Vasodilator antihypertensive drugs
Hydralazine
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Formulary
Red
20mg Injection 
   
Hydralazine
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Formulary
Green
25mg Tablets
 
   
Iloprost injection
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Restricted Drug Restricted
Red
High Cost Medicine

High Cost Medicine for tertiary specialist centres only.

Bedford Hospital is a tertiary specialist centre for vascular patients.

N.B. Can prescribe at the L&D if tertiary centre approved. No stock is kept at L&D.

 
   
Sildenafil (Revatio®)
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Restricted Drug Restricted
Red
High Cost Medicine
20mg tablets

High Cost Drug for pulmonary hypertension. Can ONLY be initiated in a tertiary centre (specialist pulmonary centre). Can prescribe for continuing treatment.

N.B. Some patients may be on 25mg or 50mg tablets (other brands or generic). This is off-label use. 
Link  MHRA DSU Nov 2018: Sildenafil (Revatio and Viagra): reports of persistent pulmonary hypertension of the newborn (PPHN) following in-utero exposure in a clinical trial on intrauterine growth restriction
   
02.05.02  Centrally acting antihypertensive drugs
Clonidine
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Formulary
Green
100microgram Tablets


 
   
Moxonidine
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Formulary
Amber
 
   
Clonidine
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Formulary
Red
0.15mg in 1mL injection 
   
Methyldopa
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Formulary
Green
250mg & 500mg Tablets 
Link  NICE CG107: Hypertension in pregnancy: diagnosis and management
   
02.05.03  Adrenergic neurone blocking drugs to top
02.05.04  Alpha-adrenoceptor blocking drugs
Doxazosin
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Formulary
Green

1mg, 2mg & 4mg Tablets 

 
   
02.05.04  Phaeochromocytoma
Phenoxybenzamine Hydrochloride
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Formulary
Red
10mg Capsules

For hypertensives episodes due to phaeochromocytoma.

Stocked in Pharmacy EDC  
   
Phentolamine 10mg/mL
(Injection)
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Formulary
Red

unlicensedunlicensed

For hypertensives episodes due to phaeochromocytoma.

L&D: Stocked in ED fridge, Pharmacy EDC fridge and Theatres 1-6 fridge.

 
   
02.05.05  Drugs affecting the renin-angiotensin system
02.05.05  Heart Failure
02.05.05.01  Angiotensin-converting enzyme inhibitors (ACE inhibitors) to top
Captopril
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Restricted Drug Restricted
Amber

12.5mg & 50mg Tablets

No new initiations - for continuing treatment only.

 
   
Enalapril
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Formulary
Green
2.5mg, 5mg, 10mg & 20mg Tablets
 
   
Lisinopril
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Formulary
Green
2.5mg, 5mg, 10mg & 20mg Tablets
 
   
Perindopril erbumine
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Formulary
Green

2mg, 4mg & 8mg Tablets

N.B. also known as peridopril tert-butylamine

 
   
Ramipril
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Formulary
Green
1.25mg, 2.5mg, 5mg & 10mg Capsules 
   
Captopril
(Oral Solution)
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Restricted Drug Restricted
Red
5mg in 5mL Oral solution
25mg in 5mL Oral Solution
Restricted to paediatric use only.
(>£100 per 100mL bottle).
For adults, tablets will disperse in water over 1 to 5 minutes. 
   
02.05.05.02  Angiotensin-II receptor antagonists
Candesartan
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Formulary
Green
2mg, 4mg, 8mg & 16mg Tablets 
   
Irbesartan
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Formulary
Green
75mg, 150mg & 300mg Tablets 
   
Losartan
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Formulary
Green
12.5mg, 25mg, 50mg & 100mg Tablets  
   
Sacubitril and valsartan (Entresto®)
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Restricted Drug Restricted
Amber
24mg/26mg, 49mg/51mg, 97mg/103mg
Must only be prescribed in accordance with NICE TA388. Can only be initiated by a heart failure specialist.
N.B. completed Patient Initiation Form must be handed in to Pharmacy with the first prescription.This is on Evolve.
 
Link  NICE TA388: Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction
   
Valsartan
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Formulary
Green

40mg, 80mg & 160mg Capsules

 
   
02.05.05.03  Renin inhibitors
02.06  Nitrates, calcium-channel blockers, and potassium-channel activators
02.06  Angina
02.06.01  Nitrates to top
Isosorbide Mononitrate
(Oral)
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First Choice
Green

10mg & 20mg Tablets

When prescribing, ensure an 8 hour nitrate free period is accounted for to reduce the risk of developing nitrate tolerance. Usually prescribe at 8am and 12pm (or 2pm).

 
Isosorbide Dinitrate
(Oral)
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Second Choice
Green

10mg & 20mg Tablets
40mg Sustained Release Tablets

Note: much more expensive than isosorbide mononitrate which is preferred. 10 and 20mg dinitrate much more expensive than 40mg SR tablets. Consider switch to isosorbide mononitrate.
No new initiations.

 
   
Glyceryl Trinitrate
(Sublingual)
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Formulary
Green

400micrograms per metered dose sublingual spray
500micrograms sublingual tablets

 
   
Isosorbide Mononitrate MR
(Oral)
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Formulary
Green

25mg, 40mg, 60mg (various brands).

Primary care: Most cost effective brand to be advised via ScriptSwitch/ Optimise

 

 
   
Isosorbide Dinitrate
(Injection)
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Formulary
Red

0.05% Injection (50mL)- ready diluted

10mg in 10mL (0.1%) Injection - For Cardiac Centre only.

 
   
02.06.02  Calcium-channel blockers
Amlodipine
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Formulary
Green
5mg & 10mg Tablets  
   
Diltiazem 120mg, 180mg, 200mg, 240mg, 300mg
(Capsules)
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Formulary
Green

ONCE A DAY dosing - 24 hour release profile.

Brands include: ADIZEM XL, DILZEM XL, TILDIEM LA. Ideally continue same brand if possible.

Primary care: Most cost effective brand to be advised via ScriptSwitch/ Optimise






 
   
Diltiazem 60mg
(MR Tablet)
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Formulary
Green

THREE TIMES DAILY dosing (TWICE DAILY in elderly).

 
   
Diltiazem 90mg, 120mg, 180mg
(SR Capsules or Tablets)
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Formulary
Green

TWICE DAILY dosing.

Brands include Adizem SR, Dilzem SR and Tildiem Retard. Ideally continue same brand if possible.

Primary care: Most cost effective brand to be advised via ScriptSwitch/ Optimise

 
   
Nicardipine 10mg/10mL
(Injection)
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Formulary
Red
 
   
Nifedipine
(Prescribe by brand due to variations in release profiles)
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Formulary
Green
Twice daily preparations:
10mg & 20mg MR Tablets (ADALAT RETARD)
10mg MR Capsules (CORACTEN SR)

Once Daily preparations:
30mg MR Capsules (CORACTEN XL)
20mg, 30mg, 60mg MR tablets (Adalat LA)
 
   
Nifedipine 5mg, 10mg
(Capsules)
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Formulary
Green

Short-acting nifedipine no longer recommended for angina or emergency or long-term management of hypertension; their use may be associated with large variations in blood pressure and reflex tachycardia.

Licensed for the treatment of Raynaud's disease.

 
   
Verapamil
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Formulary
Red
5mg in 2mL Injection  
   
Verapamil
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Formulary
Green
40mg, 80mg & 120mg tablets
120 & 240mg Sustained Release Capsules
 
Link  NICE Clinical Knowledge Summary: Headache - cluster
   
Nimodipine (Nimotop®)
(Tablets)
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Formulary
Red
30mg Tablets
 
   
Nimodipine (Nimotop®)
(Intravenous infusion)
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Formulary
Red
0.2mg in 1mL Intravenous Infusion  
   
Nifedipine 20mg/ml
(Oral drops)
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Restricted Drug Restricted
Red

unlicensed  For paediatric patients only.

 
   
02.06.03  Other anitanginal drugs
Nicorandil 10mg & 20mg
( Tablets)
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Formulary
Green
Nicorandil may cause treatment resistant ulcers - in which case it should be stopped - see link to MHRA Drug Safety Update below 
Link  MHRA Drug Safety Update (January 2016) - Nicorandil (Ikorel): now second-line treatment for angina - risk of ulcer complications
   
Ivabradine 5mg & 7.5mg
(Tablets)
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Restricted Drug Restricted
Amber
Restricted - to be initiated by consultant Cardiologist in accordance with NICE TA 267

Tablets can be split. 
Link  NICE CG126: Guidance on Stable Angina July 2011
Link  NICE TA267: Chronic heart failure - Ivabradine November 2012
   
Ranolazine (Ranexa®)
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Formulary
Amber
 
Link  NICE CG126: Guidance on Stable Angina July 2011
   
02.06.04  Peripheral vasodilators and related drugs
Naftidrofuryl Oxalate 100mg
(Capsules)
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Restricted Drug Restricted
Amber
Restricted - only to be initiated under authorisation of a specialist and in accordance with NICE TA223 or CG147.
 
Link  NICE CG147: Peripheral arterial disease: diagnosis and management
Link  NICE TA223: Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease
   
Pentoxifylline 400mg (Trental®)
(MR Tablets)
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Restricted Drug Restricted
Red

No longer recommended by NICE for the treatment of intermittent claudication in people with peripheral arterial disease.

Restricted use:
Approved by DTC for the treatment of osteoradionecrosis of the jaw (off-label use). Dose is 400mg BD. Patients are to purchase vitamin E 1000 units daily to take with this treatment.

 
   
02.06.04  Other preparations used in peripheral vascular disease
02.07  Sympathomimetics to top
MIDODRINE Tablets 2.5 mg, 5mg
Restricted Drug Restricted
Amber

BHT: Use in Paediatrics is approved for initiation by Consultant specialising in Cardiology. Transfer to GP prescribing in these patients must be preceeded by discussion between the Consultant and the GP.

 
   
02.07.01  Inotropic sympathomimetics
Dobutamine
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Formulary
Red
250mg in 5mL Injection 
   
Dopamine
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Formulary
Red
200mg in 5mL Injection  
   
Isoprenaline
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Unlicensed Drug Unlicensed
Red
0.2mg in 1mL Injection  
Link  PROTOCOL FOR THE IV ADMINISTRATION OF ISOPRENALINE
   
02.07.02  Vasoconstrictor sympathomimetics
Ephedrine
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Formulary
Red
30mg in 10mL pre-filled syringe
30mg in 1mL injection 
   
Noradrenaline / Norepinephrine
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Formulary
Red
1 in 1000 (4mL) Injection  
   
Phenylephrine
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Formulary
Red
1% Injection (1mL)
100micrograms in 1mL Injection Ampoule  
   
Metaraminol 2.5mg/ 1mL
(Injection)
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Unlicensed Drug Unlicensed
Red
 
   
02.07.03  Cardiopulmonary resuscitation
Adrenaline / Epinephrine 1 in 10,000 (dilute)
(Injection)
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Formulary
Red
10mL Pre-Filled Syringe
10mL ampoule for Injection

For emergency resuscitation only
To be used in line with Resuscitation Council guidance. 
   
02.08  Anticoagulants and protamine
Idarucizumab (Praxbind®)
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Restricted Drug Restricted
Red
Restricted - Prescribing on the recommendation of a consultant Haematologist only, for rapid reversal of dabigatran in life-threatening or uncontrolled bleeding or for emergency surgery/urgent procedures.

It is not suitable for use in over-anticoagulation caused by rivaroxaban, apixaban or edoxaban.

Currently one dose (2 vials) held in the Emergency Department fridge (antidote tray).

One further dose (2 vials) is also kept in the Pharmacy Emergency Drug Cupboard fridge. 
Link  JPC: Position Statement – High Cost Drugs Excluded from the National Tariff – Idarucizumab Injection
Link  Trust Guideline: Reversal of anticoagulation and management of bleeding in adult patients on either warfarin, nonVitamin K oral anticoagulants (NOACs) or heparin
   
02.08.01  Parenteral anticoagulants to top
02.08.01  Heparin
Heparin sodium
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Formulary
Red
1,000 Units In Sodium Chloride 0.9% (500ml) Intravenous Infusion

1,000 Units in 1mL ampoule (Preservative Free)
5,000 Units in 5mL ampoule (Preservative Free)
10,000 Units in 10ml ampoule (Preservative Free)

5,000 units in 5ml ampoule (Contains Preservatives)
25,000 Units in 5mL ampoule (Contains Preservatives)
 
   
02.08.01  Low molecular weight heparins
Tinzaparin
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First Choice
Red
1st line for treatment and prophylaxis of DVT and PE:

8,000 Units in 0.8mL Pre-Filled Syringe
10,000 Units in 0.5mL Pre-Filled Syringe
12,000 Units in 0.6mL Pre-Filled Syringe
14,000 Units in 0.7mL Pre-Filled Syringe
16,000 Units in 0.8mL Pre-Filled Syringe
18,000 Units in 0.9mL Pre-Filled Syringe

40,000 Units in 2ml vial

 
Dalteparin
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Restricted Drug Restricted
Red

Paediatrics only and if recommended by GOSH

 
   
Enoxaparin
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Formulary
Red
For treatment of ACS in renal patients only:

60mg in 0.6mL Injection
80mg in 0.8mL Injection
100mg in 1mL Injection
120mg in 0.8mL Injection
150mg in 1mL Injection

 
   
02.08.01  Heparinoids
Danaparoid 750 Units in 0.6mL (Orgaran®)
( Injection )
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Restricted Drug Restricted
Red
Restricted - prescribing only on the advice of a Consultant Haematologist, for heparin induced thrombocytopenia (HIT)
N.B. Very expensive. Consider fondaparinux first. 
   
02.08.01  Hirudins
Bivalirudin 250mg (Angiox®)
(Injection)
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Restricted Drug Restricted
Red
Restricted - prescribing by Cardiologists only for patients intolerant to first line treatment options for ACS STEMI and in accordance with NICE TA 230 Bivalirudin for the treatment of ST-segment-elevation myocardial infarction.  
Link  NICE CG94: Unstable angina and NSTEMI
Link  NICE TA230 : Bivalirudin for the treatment of STEMI, 2011
   
02.08.01  Heparin flushes to top
Heparin sodium 200units / 2mL (Canusal®)
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Second Choice
Amber
Not for routine flushing - use sodium chloride 0.9%.

For maintaining intravenous catheters when recommended by vascular access nurse. 
   
Heparin sodium 50units/5mL (Hepsal®)
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Second Choice
Red

Not for routine flushing - use sodium chloride 0.9%.

For maintaining intravenous catheters when recommended by vascular access nurse.

 
   
02.08.01  Epoprostenol
Epoprostenol 500mcg (Generic brand )
(Injection)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

Restricted - for use on NICU, ITU and SCBU and in reynaud's disease by rheumatologists.

N.B. Must not use Flolan brand with L&D protocol as the formulation has changed (April 2017)and no longer works with the protocol. (The new Flolan formulation has a pH of 12, is diluted to a different concentration and has shorter stability).

 
Link  Epoprostenol - Protocol to use for Raynaud’s Disease, updated Feb 2018
   
02.08.01  Fondaparinux
Fondaparinux 2.5mg in 0.5mL  (Arixtra®)
(Injection )
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
Restricted to:
1. Prescribing by acute medical team for suspected ACS. Refer Trust Guidelines.
2. Prescribing by Consultant Haematologists for patients intolerant of tinzaparin and enoxaparin (eg. due to heparin-induced thrombocytopenia (HITT) or skin rash)  
Link  Fondaparinux Prescribing Guidance (July 2016)
   
02.08.02  Oral anticoagulants
Warfarin 1mg, 3mg & 5mg
(Tablets)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ensure dose is written in patient's yellow book upon discharge and anti-coagulation clinic appointment made.
 
   
Edoxaban 30mg & 60mg (Lixiana®)
( Tablets)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Refer to NICE TA354/TA355 AND anti-coagulation guidelines.

N.B. edoxaban has not been studied in patients with prosthetic heart valves and its use is not recommended in these patients (see MHRA DSU Oct 18 link under rivaroxaban).

 
Link  MHRA DSU June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  NICE TA354: Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism
Link  NICE TA355: Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation
   
Apixaban 2.5mg & 5mg (Eliquis®)
( Film Coated Tablets)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Refer to NICE TA275/TA341 AND anti-coagulation guidelines.

N.B. not advised to prescribe at extremes of bodyweight (120kg).

Compared to apixaban exposure in subjects with body weight of 65 to 85 kg, body weight > 120 kg was associated with approximately 30% lower exposure and body weight < 50 kg was associated with approximately 30% higher exposure. (from manufacturers SPC).

N.B. apixaban has not been studied in patients with prosthetic heart valves and its use is not recommended in these patients (see MHRA DSU Oct 18 link under rivaroxaban).

 
Link  MHRA DSU June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  NICE TA275: Stroke and systemic embolism (prevention, non-valvular atrial fibrillation) - apixaban
Link  NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
   
Dabigatran 75mg & 110mg (Pradaxa®)
(Capsules)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Refer to NICE TA157/TA249/TA327 AND anti-coagulation guidelines.

N.B. dabigatran is contraindicated in patients with prosthetic heart valves requiring anticoagulant treatment. See MHRA Drug Safety Update Oct 2018 (link in rivaroxaban section below).

 
Link  MHRA DSU June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  NICE TA157: VTE prevention post hip / knee surgery - dabigatran
Link  NICE TA249: Dabigatran for Stroke prevention in AF
Link  NICE TA327: Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
   
Rivaroxaban 10mg, 15mg & 20mg (Xarelto®)
( Film Coated Tablets)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Refer to NICE TA256/TA261/TA287/TA335 AND anti-coagulation guidelines.

L&D: 10mg tablets also approved for 2nd line use in needle-phobic patients for thromboprophylaxis in patients with temporary limb immobilisation by the emergency department doctors (dose = 10mg once daily).

Rivaroxaban is not authorised for thromboprophylaxis in patients with prosthetic heart valves, including patients who have undergone TAVR, and should not be used in such patients. See MHRA update below.

 
Link  MHRA DSU June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  MHRA DSU Oct 2018: Rivaroxaban (Xarelto▼) after transcatheter aortic valve replacement: increase in all-cause mortality, thromboembolic and bleeding events in a clinical trial
Link  NICE TA256: Rivaroxaban for AF
Link  NICE TA261: Rivaroxaban for treatment of DVT
Link  NICE TA287: Rivaroxaban for treating PE and preventing recurrent venous thromboembolism
Link  NICE TA335: Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome
   
Phenindione 10mg
(Tablets)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

No new initiations.

Review current patients and switch to more cost-effective and available anticoagulant if possible.

 
   
02.08.02  Stroke prevention in AF
02.08.02  Atrial Fibrillation to top
02.08.02  VTE treatment
02.08.02  VTE prophylaxis in hip/knee surgery
02.08.02  VTE Prophylaxis
02.08.03  Protamine sulphate
Protamine Sulphate 50mg/5mL (Prosulf®)
(Injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
   
02.09  Antiplatelet drugs to top
Aspirin (antiplatelet)
View adult BNF View SPC online View childrens BNF
Formulary
Green
75mg & 300mg dispersible tablet


Red Traffic Light  150mg & 300mg Suppositories unlicensedunlicensed


 
   
Tirofiban 250microgram in 1ml (Aggrastat®)
(Concentrate for intravenous infusion)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
Restricted - Only to be prescribed under Consultant Cardiologist authorization and in accordance with NICE TA47 which has been partially updated by NICE CG 94 - Unstable angina and NSTEMI: the early management of unstable angina and non-ST-segment-elevation myocardial infarction.

 
Link  NICE TA 47: The use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes
   
Clopidogrel 75mg
(Tablets )
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Formulary
Green
 
Link  NICE TA80: Acute coronary syndromes - clopidogrel
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
Link  Drug Safety Update: Clopidogrel and proton pump inhibitors: interaction
   
Prasugrel (Efient®)
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Restricted Drug Restricted
Amber
Restricted - Only to be initiated under Cardiology authorization and in accordance with NICE TA182/TA317

5mg & 10mg Film Coated Tablets 
Link  NICE TA182: Acute coronary syndrome - prasugrel
Link  NICE TA317: Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes (review of technology appraisal guidance 182)
   
Ticagrelor 90mg (Brilique®)
(Tablets )
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Formulary
Amber
1st line in combination with aspirin in ACS as per trust protocol and NICE TA420.

Strong CYP3A4 inhibitors (e.g. clarithromycin, ketoconazole, itraconazole, voriconazole,nefazodone, ritonavir and atazanavir) interact with ticagrelor and increase its plasma level by up to five times. Please be mindful of drug interactions when prescribing this.
 
Link  NICE TA420: Ticagrelor for preventing atherothrombotic events after MI
   
Ticagrelor 90mg (Brilique®)
(Orodispersible tablets)
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Restricted Drug Restricted
Amber

1st line in combination with aspirin in ACS as per trust protocol and NICE TA420.

Orodispersible tablet will dissolve on the tongue for patients with swallowing difficulties or can be dispersed in water to be flushed down a nasogastric tube.

Strong CYP3A4 inhibitors (e.g. clarithromycin, ketoconazole, itraconazole, voriconazole,nefazodone, ritonavir and atazanavir) interact with ticagrelor and increase its plasma level by up to five times. Please be mindful of drug interactions when prescribing this.

 
Link  NICE TA420: Ticagrelor for preventing atherothrombotic events after MI
   
Dipyridamole
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Formulary
Green
100mg Tablets
200mg Sustained Release Capsules
50mg in 5mL Suspension  
   
02.10  Stable angina, acute coronary syndromes, and fibrinolysis
02.10.01  Management of stable angina and acute coronary syndromes
02.10.02  Fibrinolytic drugs
Alteplase 10mg, 20mg & 50mg (Actilyse®)
(Injection)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

Restricted - Only to be prescribed under specialist supervision for PE, MI, post-stroke. Refer to trust guidelines and NICE TA52 and TA264.

Restricted: approved for use by respiratory consultants for severe empyema (unlicensed use) with iintrapleural dornase alfa. See attached protocol for criteria and further details.

 
Link  NICE TA264: Ischaemic stroke (acute) - alteplase
Link  NICE TA52: Guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction
Link  PROTOCOL FOR INTRAPLEURAL (IP) ALTEPLASE AND DORNASE ALFA FOR THE TREATMENT OF EMPYEMA
   
Streptokinase 1.5 Mega Unit
(Injection)
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Formulary
Red
Restricted - Only to be prescribed under specialist supervision for acute STEMI.  
Link  TA52: Guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction
   
Urokinase
View adult BNF View SPC online View childrens BNF
Formulary
Red

10,000 Units & 25,000 Units Injection

For CVC occlusion
Dilute 10 000 units in 2ml 0.9% sodium chloride and follow Trust guidelines (see link).

Currently Unavailable.

For Luton & Dunstable Hospital - substitute Taurolock 25000 units:

Instructions for use:

Reconstitute Taurolock with the diluent provided (5mL ampoule). Withdraw a 10,000 unit dose (2mL) then follow the procedure on the L&D Trust guideline for a 60 minute dwell time.

Please note, however, that the manufacturer of Taurolock advise that this is not for systemic use and that it should be aspirated once the dwell time is finished.

 
Link  Management of CVC Occlusion
   
02.11  Antifibrinolytic drugs and haemostatics
Tranexamic Acid 500mg
( Tablets)
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Formulary
Green


 
   
Tranexamic Acid 500mg in 5mL
(Injection )
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Formulary
Red

 
   
02.11  Blood-related products to top
02.12  Lipid-regulating drugs
Alirocumab 75mg/mL, 150mg/mL (Praluent®)
(Pre-filled pen or syringe)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
High Cost Medicine
FOR ALL PRESCRIBING - a completed and approved HIGH COST DRUG compliance form is required. Complete on Blueteq (link on front page).

Prescribing initiation and continuation by Consultant Chemical Pathologist only.

For treatment of primary hypercholesterolaemia (heterozygous familial and non-familial) and mixed dyslipidaemia in accordance with NICE TA393 (alirocumab). 
Link  NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
Evolocumab 140mg/mL (Repatha® )
(Pre-filled pen or syringe)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
High Cost Medicine
FOR ALL PRESCRIBING - a completed and approved HIGH COST DRUG compliance form is required. Complete on Blueteq (link on front page).

Prescribing initiation and continuation by Consultant Chemical Pathologist only.

For treatment of primary hypercholesterolaemia (heterozygous familial and non-familial) and mixed dyslipidaemia in accordance with NICE TA394 (evolocumab). 
Link  NICE TA 394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
02.12  Bile acid sequestrants
Colestyramine  (Questran®)
(Sachet)
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Formulary
Green
4g sachet
4g low-sugar sachet (contains aspartame) 
   
02.12  Ezetimibe
Ezetimibe 10mg (Ezetrol®)
(Tablets )
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green
In accordance with NICE TA385  
Link  NICE TA385: Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia
Link  NICE CG71: Familial hypercholesterolaemia: identification and management
   
02.12  Fibrates
Bezafibrate
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Formulary
Green
200mg Tablets
400mg Modified Release Tablets  
   
Fenofibrate 200mg, 267mg
(Capsules)
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Formulary
Green
 
   
02.12  Statins to top
Atorvastatin
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First Choice
Green
10mg, 20mg, 40mg & 80mg Tablets 
Simvastatin
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First Choice
Green
10mg, 20mg & 40mg Tablets  
Rosuvastatin
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber
Restricted to 4th-line use in familial hypercholesterolaemia and secondary prevention where target levels have not been met with other statins. 
   
Pravastatin
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
02.12  Nicotinic acid group
02.12  Omega-3 fatty acid compounds
02.13  Local sclerosants
Sodium Tetradecyl Sulphate (Fibro-Vein®)
Formulary
Red
1% injection (2mL)
3% Injection (2mL)

Restricted - prescribing by vascular team only in accordance with NICE CG 168 Varicose veins in the legs. 
Link  NICE CG168: Varicose veins: diagnosis and management
   
 ....
 Non Formulary Items
Abciximab 10mg/5mL  (Reopro®)
(Injection)

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Non Formulary

Product unavailable since July 2018 but has now been DISCONTINUED (May 2019)

 
Acebutolol  (Sectral®)

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Non Formulary
 
Acenocoumarol  (Sinthrome®)

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Non Formulary
 
Acipimox  (Olbetam®)

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Non Formulary
 
Aliskiren  (Rasilez®)

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Non Formulary
 
Ambrisentan

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Non Formulary
High Cost Medicine
 
Amlodipine and Valsartan  (Exforge®)

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Non Formulary
 
Antithrombin III  (Kybemin®)

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Non Formulary
High Cost Medicine
 
Aprotinin  (Trasylol®)

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Non Formulary
 
Argatroban  (Exembol®)

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Non Formulary
 
Atenolol and Co-amilozide  (Kalten®)

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Non Formulary
 
Atenolol and Nifedipine  (Beta-Adalat®)

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Non Formulary
 
Atenolol and Nifedipine  (Tenif®)

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Non Formulary
 
Atorvastatin and Ezetemibe  (Atozet®)

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Non Formulary
 
Atorvastatin and Ezetemibe  (Atozet®)

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Non Formulary
 
Azilsartan

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Non Formulary
 
Bemiparin

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Non Formulary
 
Cytotoxic Drug  Bendroflumethiazide  (Bendro®)
(Use 2.5mg)

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Non Formulary
High Cost Medicine
Cancer Drugs Fund
 
Bezafibrate  (Bezalip® Mono)

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Non Formulary
 
Bosentan  (Tracleer®)

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Non Formulary
High Cost Medicine
 
Burinex K®

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Non Formulary
 
Cangrelor

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Non Formulary
 
Captopril and Hydrochlorothiazide  (Capozide®)

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Non Formulary
 
Captopril and Hydrochlorothiazide  (Co-zidocapt®)

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Non Formulary
 
Catridecacog  (NovoThirteen®)

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Non Formulary
High Cost Medicine
 
Celiprolol Hydrochloride

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Non Formulary
 
Centyl K®

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Non Formulary
 
Chlorothiazide tablets 500mg

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Non Formulary

unlicensedunlicensed

 
Chlortalidone

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Non Formulary
 
Cilazapril  (Vascace®)

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Non Formulary
 
Cilostazol  (Pletal®)

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Non Formulary
Black
Not recommended by NICE TA223 for the treatment of intermittent claudication in people with peripheral arterial disease.
 
Ciprofibrate  (Modalim®)

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Non Formulary
 
Clevidipine  (Cleviprex®)

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Non Formulary
 
Clopidogrel 300mg  (Plavix®)

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Non Formulary
 
Co-amilozide
(Amiloride and Hydrochlorothiazide)

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Non Formulary
Black

2.5/25mg Tablets
5/50mg Tablets

Link  MHRA DSU Nov 2018: Hydrochlorothiazide: risk of non-melanoma skin cancer, particularly in long-term use
 
Co-flumactone

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Non Formulary
 
Colesevelam  (Cholestagel®)

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Non Formulary
 
Colestipol  (Colestid®)

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Non Formulary
 
Co-tenidone (atenolol and chlortalidone)

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Non Formulary
 
Co-triamterzide

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Non Formulary
 
Cozaar- Comp®

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Non Formulary
 
Cyclopenthiazide  (Navidrex®)

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Non Formulary
 
Digitoxin

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Non Formulary
 
Dipyridamole and Aspirin

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Non Formulary
 
Disopyramide  (Rythmodan® Retard)

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Non Formulary
 
Diumide-K Continus®

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Non Formulary
 
Dopamine Hydrochloride  (Select-A-jet® Dopamine)

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Non Formulary
 
Dopexamine

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Non Formulary
Red
50mg in 5mL Injection

N.B. THIS PRODUCT WAS DISCONTINUED IN APRIL 2016.
 
Doxazosin 4mg, 8mg
(MR Tablets)

View adult BNF View SPC online View childrens BNF
Non Formulary Switch to immediate release tablets which can be given once daily.
 
Drotrecogin Alfa (Activated)  (Xigris®)

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Non Formulary
 
Dyazide®

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Non Formulary
 
Enalapril and Hydrochlorothiazide  (Innozide®)

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Non Formulary
 
Enalapril Meleate  (Innovace®)

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Non Formulary
 
Enoximone  (Perfan®)

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Non Formulary
 
Ephedrine

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Non Formulary
 
Eprosartan  (Teveten®)

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Non Formulary
 
Eptifibatide  (Integrilin®)

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Non Formulary
 
Etamsylate  (Dicynene®)

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Non Formulary
 
Ethanolamine Oleate

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Non Formulary
Green
Discontinued
 
Factor IX Fraction, Dried

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Non Formulary
High Cost Medicine
 
Factor IX, recombinant  (Rixubis®)

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Non Formulary
 
Factor VIIa (Recombinant)  (Novo 7®)

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Non Formulary
High Cost Medicine
 
Factor VIII + von Willebrand factor  (Voncento®)

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Non Formulary
 
Factor VIII Fraction, Dried

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Non Formulary
High Cost Medicine
 
Factor VIII Inhibitor Bypassing Fraction

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Non Formulary
High Cost Medicine
 
Factor XIII Fraction, Dried

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Non Formulary
High Cost Medicine
 
Felodipine

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Non Formulary
 
Felodipine  (Plendil®)

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Non Formulary
 
Fenofibrate  (Lipantil®)

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Non Formulary
 
Fenofibrate  (Supralip® 160)

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Non Formulary
 
Fluvastatin  (Lescol®)

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Non Formulary
 
Fluvastatin  (Lescol® XL)

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Non Formulary
 
Fosinopril

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Non Formulary
 
Fosinopril Sodium  (Staril®)

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Non Formulary
 
Fresh Frozen Plasma

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Non Formulary
 
Frusene®

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Non Formulary
 
Gemifibrozil

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Non Formulary
 
Gemifibrozil  (Lopid®)

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Non Formulary
 
Glyceryl Trinitrate  (Deponit®)

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Non Formulary
 
Glyceryl Trinitrate  (Minitran®)

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Non Formulary
 
Glyceryl Trinitrate  (Nitro-Dur®)

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Non Formulary
 
Glyceryl Trinitrate  (Nitromin®)

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Non Formulary
 
Glyceryl Trinitrate  (Nitronal®)

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Non Formulary
 
Glyceryl Trinitrate  (Percutol®)

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Non Formulary
 
Glyceryl Trinitrate  (Suscard®)

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Non Formulary
 
Glyceryl Trinitrate  (Sustac®)

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Non Formulary
 
Glyceryl Trinitrate  (Transiderm-Nitro®)

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Non Formulary
 
Glyceryl Trinitrate  (Trintek®)

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Non Formulary
 
Human fibrinogen & thrombin  (Raplixa® )

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Non Formulary
 
Human fibrinogen & thrombin  (Raplixa® )

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Iloprost nebules  (Vantavis®)

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Non Formulary

High Cost Medicine for tertiary specialist centres only.

N.B. There are no funding arrangements for our locality. No stock is kept.

 
Imidapril  (Tanatril®)

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Non Formulary
 
Indoramin  (Baratol®)

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Non Formulary
 
Indoramin  (Doralese®)

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Non Formulary
 
Inositol Nicotinate  (Hexopal®)

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Non Formulary
Black
Not recommended by NICE TA223 for the treatment of intermittent claudication in people with peripheral arterial disease.
 
Isosorbide Dinitrate  (Angitak®)

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Non Formulary
 
Isosorbide Dinitrate  (Codocard® Retard)

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Non Formulary
 
Isosorbide Mononitrate  (Imdur®)

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Non Formulary
 
Isosorbide Mononitrate  (Isib® 60XL)

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Non Formulary
 
Isosorbide Mononitrate  (Ismo®)

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Non Formulary
 
Isosorbide Mononitrate  (Ismo® Retard)

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Non Formulary
 
Isosorbide Mononitrate  (Isodur®)

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Non Formulary
 
Isosorbide Mononitrate  (Isotard®)

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Non Formulary
 
Isosorbide Mononitrate  (Modisal®)

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Non Formulary
 
Isosorbide Mononitrate  (Modisal® XL)

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Non Formulary
 
Isosorbide Mononitrate  (Mononil® XL)

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Non Formulary
 
Isosorbide Mononitrate  (Monosorb® XL)

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Non Formulary
 
Isosorbide Mononitrate  (Monosorb® XL 60)

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Non Formulary
 
Isosorbide Mononitrate  (Zemon®)

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Non Formulary
 
Isradipine  (Prescal®)

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Non Formulary
 
Kalspare®

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Non Formulary
 
Lacidipine  (Motens®)

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Non Formulary
 
Lasikal®

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Non Formulary
 
Lasilactone®

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Non Formulary
 
Lepirudin

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Non Formulary
 
Lercanidipine

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Non Formulary
 
Lisinopril and Hydrochlorothiazide  (Carace® Plus)

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Non Formulary
 
Lisinopril and Hydrochlorothiazide  (Lisicostad®)

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Non Formulary
 
Lisinopril and Hydrochlorothiazide  (Zestoretic®)

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Non Formulary
 
Lomitapide  (Lojuxta®▼)

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Non Formulary
High Cost Medicine
 
Macitentan  (Opsumit®
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Non Formulary
High Cost Medicine

High Cost Medicine for tertiary specialist centres only.

N.B. There are no funding arrangements for our locality. No stock is kept.

 
Metaraminol

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Non Formulary
 
Metoprolol Tartrate  (Betaloc-SA®)

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Non Formulary
 
Metoprolol Tartrate  (Lopresor® SR)

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Non Formulary
 
Mexiletine

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Non Formulary
Black

Ventricular arrhythmia: - Prescribing to remain with Specialist in Tertiary Centre (no prescribing in primary/secondary care). Medication is unlicensed and supplied on a named patient basis

Symptomatic treatment of myotonia in adult patients with non-dystrophic myotonic disorders: - no prescribing in primary/secondary care, cost £5000/100 capsules and awaiting NICE TA.

 
Minoxidil 5mg
(Tablets)

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Non Formulary
 
Moexipril  (Perdix®)

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Non Formulary
 
Moracizine

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Non Formulary
 
Moxisylyte  (Opilon®)

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Non Formulary
 
Nadolol  (Corgard®)

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Non Formulary
 
Navispare®

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Non Formulary
 
Nebivolol  (Nebilet®)

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Non Formulary
 
Neo-NaClex-K®

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Non Formulary
 
Nicardipine 20mg, 30mg
(Capsules)

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Non Formulary
 
Nicotinic Acid  (Niaspan®)

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Non Formulary
 
Nicotinic acid/ laropiprant  (Tredaptive ®)

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Non Formulary
 
Nisoldipine  (Syscor® MR)

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Non Formulary
 
Olmesartan  (Sevikar®)

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Non Formulary
Black
THE most expensive angiotensin-II receptor antagonist (about 25 times more than valsartan). Must not be initiated.
 
Omega-3-Acid Ethyl Esters  (Omacor®)
(Capsules)

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Non Formulary
Black
GP's not to prescribe this. On the CCG drop-list since no good evidence to support it. See JPC bulletin on GP-ref website (link below).
Patients to be encouraged to get omega 3 from their diet. Review patients who come in on this.
Link  JPC Advice & Guidance
 
Omega-3-Marine Triglycerides  (Maxepa®)

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Non Formulary
 
Oxerutins  (Paroven®)

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Non Formulary
 
Oxprenolol Hydrochloride

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Non Formulary
 
Oxprenolol Hydrochloride and Cyclopenthiazide  (Trasidrex®)

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Non Formulary
 
Perindopril Arginine  (Coversyl® Arginine)

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Non Formulary
Black

Prescribe perindopril erbumine 4mg for 5mg perindopril arginine

 
Perindopril Erbumine  (Coversyl®)

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Non Formulary
Black

Prescribe generically

 
Pindolol

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Non Formulary
 
Pindolol  (Visken®)

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Non Formulary
 
Pindolol and Clopamide  (Viskaldix®)

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Non Formulary
 
Prazosin

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Non Formulary
Black

500microgram Tablets
1mg Tablets

 
Prazosin

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Non Formulary
 
Procainamide

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Non Formulary
 
Protein C Concentrate  (Ceprotin®)

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Non Formulary
High Cost Medicine
 
Prothrombin Complex Concentrate  (Octaplex®)

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Non Formulary
High Cost Medicine

Obtain advice and supply from Haematology.

 
Quinapril  (Accupro®)

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Non Formulary
 
Quinapril and Hydrochlorothiazide

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Non Formulary
 
Ramipril and Felodipine  (Triapin®)

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Non Formulary
 
Rasitro®

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Non Formulary
 
Reteplase  (Rapilysin®)

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Non Formulary DISCONTINUED December 2015
 
Riociguat  (Adempas®)

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Non Formulary
High Cost Medicine
 
Sevikar HCT®

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Non Formulary
 
Simoctocog alfa  (Nuwiq)

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Non Formulary
 
Simvastatin and Ezetimibe  (Inegy®)

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Non Formulary
 
Sitaxentan Sodium  (Thelin®)

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Non Formulary
 
Sodium Nitroprusside

Non Formulary

DISCONTINUED

 
Sotalol Hydrochloride  (Beta-Cardone®)

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Non Formulary
 
Tadalafil  (Adcirca®)

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Non Formulary
 
Telmisartan

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Non Formulary
 
Tenecteplase  (Metalyse®)

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Non Formulary
 
Terazosin

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Non Formulary
 
Terazosin  (Hytin®)

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Non Formulary
 
Timolol

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Non Formulary
 
Timolol Maleate and Bendroflumethiazide  (Prestim®)

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Non Formulary
 
Timolol Maleate and Co-amilozide  (Moducren®)

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Non Formulary
 
Tolazoline

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Non Formulary
 
Torasemide

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Non Formulary
 
Trandolapril  (Gopten®)

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Non Formulary
 
Trandolapril and Verapamil  (Tarka®)

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Non Formulary
 
Triamterene  (Dytac®)

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Non Formulary
 
Vorapaxar  (Zontivity®)

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Non Formulary
 
Xipamide  (Diurexan®)

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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
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
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

Red

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations   

Amber SCG

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.   

Black

A decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.   

netFormulary