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Birmingham, Sandwell, Solihull and environs APC Formulary
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.01  Positive inotropic drugs
02.01.01  Cardiac glycosides
Digoxin Tablets
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First Choice
Green

Use only if still symptomatic despite optimal treatment of HF with atrial fibrillation.

Take extra caution in the elderly who may be more susceptible to digitalis toxicity.
 
Digoxin Elixir
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Formulary
Green
Use only if still symptomatic despite optimal treatment of HF with atrial fibrillation.

Take extra caution in the elderly who may be more susceptible to digitalis toxicity.
 
   
Digoxin Injection
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Formulary
Green
 
   
02.01.01  Digoxin-specific antibody
Digoxin specific antibody fragments (Digifab®)
((antidote))
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
   
02.01.02  Phosphodiesterase type-3 inhibitors
Enoximone (Perfan®)
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Formulary
Red
 
   
02.02  Diuretics to top
02.02.01  Thiazides and related diuretics
Chlortalidone Tablets
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Formulary
Green
 
   
Indapamide
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Formulary
Green
Use 2.5mg tablets only 
   
Metolazone
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Formulary
Amber
Specialist recommendation (unlicensed)
Use with local trust approval.
Available from "special-order" manufacturers or specialist-importing companies. 
   
Bendroflumethiazide
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Formulary
Green

2.5mg dose (higher doses are not indicated in hypertension)

 
   
02.02.02  Loop diuretics
Bumetanide
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Formulary
Green
 
   
Furosemide
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Formulary
Green
  • Tablets
  • Oral solution
  • Injection
     
  •    
    02.02.03  Potassium-sparing diuretics and aldosterone antagonists
    Amiloride Hydrochloride
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • Tablets
  • Oral solution 
  •    
    02.02.03  Aldosterone antagonists
    Spironolactone tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Eplerenone tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
    Link  NICE CG108: Chronic heart failure
       
    02.02.04  Potassium-sparing diuretics with other diuretics to top
    Co-amilofruse (furosemide and amiloride)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Combination products should be avoided, unless compliance is an issue.  
       
    02.02.05  Osmotic diuretics
    Mannitol infusion
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    02.02.06  Mercurial diuretics
    02.02.07  Carbonic anhydrase inhibitors
    Acetazolamide
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    Formulary
    Amber
    Itracranial hypertension 
       
    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
    02.03.02  Supraventricular arrhythmias
    Adenosine injection
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    Formulary
    Red
     
       
    Dronedarone tablets (Multaq®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    To be used in line with NICE guidance 
    Link  NICE TA197: Atrial fibrillation - dronedarone
       
    02.03.02  Supraventricular and ventricular arrhythmias
    Amiodarone injection
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    Formulary
    Red
     
       
    Amiodarone tablets
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    Formulary
    Amber
  • Specialist initiation
     
  •    
    Disopyramide capsules
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    Formulary
    Amber
     
       
    Disopyramide injection
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Flecainide injection
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Flecainide tablets
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    Formulary
    Amber
     
       
    Propafenone hydrochloride
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    02.03.02  Ventricular arrhythmias to top
    Mexiletine hydrochloride
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    unlicensedunlicensed
    Use with local trust approval.
    Available from "special-order" manufacturers or specialist importing companies. 
       
    Lidocaine hydrochloride
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    02.04  Beta-adrenoceptor blocking drugs
    Atenolol
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Bisoprolol
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Carvedilol
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Esmolol injection
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Labetalol injection
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    Formulary
    Red
     
       
    Labetalol tablets
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    Restricted Drug Restricted
    Green
    Restricted Item Specific indication- Pregnancy 
       
    Metoprolol tartrate
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    Formulary
    Green
  • Tablets
  • Modified Release tablets 
  •    
    Metoprolol tartrate injection
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    Formulary
    Red
     
       
    Propranolol
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    Formulary
    Green
  • Tablets
  • Modified Release capsules 
  •    
    Sotalol
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    Formulary
    Amber
    Anti Arrhythmic 
       
    02.05  Drugs affecting the renin-angiotensin system and some other antihypertensive drugs
    02.05.01  Vasodilator antihypertensive drugs
    Hydralazine tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Minoxidil tablets (Loniten®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Bosentan (Tracleer®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    NHS England commissioned 
       
    Iloprost nebules (Vantavis®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    NHS England commissioned 
       
    Metirosine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Sildenafil (Revatio®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    NHS England commissioned 
       
    Sodium nitroprusside
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Injection (Secondary Care only)

     
       
    02.05.02  Centrally acting antihypertensive drugs
    Clonidine Hydrochloride tablets (Catapres®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Methyldopa tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Moxonidine tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    02.05.03  Adrenergic neurone blocking drugs to top
    02.05.04  Alpha-adrenoceptor blocking drugs
    Doxazosin tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Plain tablets

    Black Traffic Light  Modified release tablets are non- formulary 
    Link  Patient Information Leaflet
    Link  UKMI Q&A: Switching from modified release doxazosin to standard release doxazosin in patients with hypertension
       
    02.05.04  Phaeochromocytoma
    Phenoxybenzamine Hydrochloride capsules
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    Check availibility 
       
    02.05.05  Drugs affecting the renin-angiotensin system
    02.05.05  Heart Failure
    Sacubitril valsartan (Entresto ® View adult BNF View SPC online View childrens BNF Formulary
    Amber
  • In line with NICE
  • transfer to Primary care at 3 months following initiation by Heart Failure specialist supported by a RICaD. Click here to access RICaD
     
  • Link  NICE TA388: Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction (April 2016)
       
    02.05.05.01  Angiotensin-converting enzyme inhibitors (ACE inhibitors) to top
    Lisinopril tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Perindopril erbumine tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Ramipril capsules
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Captopril tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    For existing patients only 
       
    Enalapril tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    For existing patients only. 
       
    02.05.05.02  Angiotensin-II receptor antagonists
    Candesartan cilexetil tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Irbesartan tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Losartan tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Valsartan capsules
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    02.05.05.03  Renin inhibitors
    Aliskiren (Rasilez®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    Supported by RICaD, see link below. 
    Link  RICaD: Aliskiren in essential hypertension.
       
    02.06  Nitrates, calcium-channel blockers, and potassium-channel activators
    02.06  Angina
    02.06.01  Nitrates to top
    Glyceryl Trinitrate Injection
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Secondary Care use only

     
       
    Glyceryl Trinitrate MR Bucaal Tabletsq
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Glyceryl Trinitrate patches
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Glyceryl Trinitrate SL spray and SL tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Isosorbide Dinatrate
    (Oral)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Isosorbide Mononitrate
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablets
     
       
    Isosorbide Mononitrate MR
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    APC preferred brands:-
  • Chemydur XL tablets
  • Monomil XL tablets
     
  •    
    02.06.02  Calcium-channel blockers
    Amlodipine
    View adult BNF View SPC online View childrens BNF
    First Choice
    Green
     
    Diltiazem
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    60mg tablets - FIRST LINE. For administration three times a day. No requirement for brand name prescribing.

    Modified- release formulations should be prescribed by brand name.

    Brand rationalisation- APC preferred brands:(in alphabetical order, does not suggest order of preference)
  • Adizem SR capsules and tablets
  • Adizem XL capsules
  • Angitil SR capsules
  • Angitil XL capsules
  • Tildiem LA capsules
  • Tildiem Retard tablets 
  •    
    Felodipine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Brand rationalisation - APC preferred brands:-
  • Cardioplen XL
  • Felotens XL
     
  •    
    Nifedipine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Standard release capsules
    and
    Modified Release preparations: Brand rationalisation- APC preferred brands:-
  • Adipine MR tablets
  • Adipine XL tablets
  • Coracten SR capsules
  • Coracten XL capsules 
  •    
    Nimodipine (Nimotop®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Verapamil
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Standard release tablets
    and
    Modified release formulations: Brand rationalisation - APC preferred brand:
  • Securon SR tablets

     
  • Link  UKMI Q&A: Evidence for verapamil for cluster headache
       
    02.06.03  Other anitanginal drugs
    Ivabradine tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    Supported by a RICaD, see link below. 
    Link  NICE CG126: Management of Stable Angina
    Link  NICE TA267: Chronic heart failure - ivabradine
    Link  RICaD: Ivabradine in chronic heart failure / chronic stable angina.
       
    Nicorandil tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    Specialist initiation 
       
    Ranolazine (Ranexa®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    Supported by RICaD, see link below.  
    Link  NICE CG126: Management of Stable Angina
    Link  RICaD: Ranolazine in chronic stable angina.
       
    Perhexiline tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    02.06.04  Peripheral vasodilators and related drugs
    Naftidrofuryl Oxalate capsules
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    02.06.04  Other preparations used in peripheral vascular disease
    02.07  Sympathomimetics to top
    02.07.01  Inotropic sympathomimetics
    Dobutamine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Dopamine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Isoprenaline
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    02.07.02  Vasoconstrictor sympathomimetics
    Ephedrine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Metaraminol
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Midodrine (Bramox®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
  • Transfer to Primary Care supported by an ESCA.
  • Click here for ESCA
     
  •    
    Noradrenaline / Norepinephrine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Phenylephrine
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    02.07.03  Cardiopulmonary resuscitation
    02.08  Anticoagulants and protamine
    02.08.01  Parenteral anticoagulants to top
    02.08.01  Heparin
    Heparin sodium injection
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    02.08.01  Low molecular weight heparins
    Enoxaparin
    View adult BNF View SPC online View childrens BNF
    Formulary Green Traffic Light  Single use in suspected DVT

    Red Traffic Light  For all other indications.

    The APC's view is that on clinical grounds, the status for certain indications approved by APC should be amber, supported by an ESCA.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.(ESCAs to be developed).  
       
    Tinzaparin
    View adult BNF View SPC online View childrens BNF
    Formulary Green Traffic Light  For single dose in suspected DVT.


    Red Traffic Light For all other indications.

    The APC's view is that on clinical grounds, the status for certain indications approved by APC should be amber, supported by an ESCA.
    HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED.(ESCAs to be developed).  
       
    02.08.01  Heparinoids
    Danaparoid (Orgaran®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    02.08.01  Hirudins
    Bivalirudin (Angiox®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
    Link  NICE CG94: Unstable angina and NSTEMI
       
    02.08.01  Heparin flushes to top
    TauroLock (TauroLock HEP 500 ®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    02.08.01  Epoprostenol
    Epoprostenol (Flolan®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    02.08.01  Fondaparinux
    Fondaparinux (Arixtra®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Hospital only 
       
    02.08.02  Oral anticoagulants
    Warfarin tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    APC preferred agent: this recommendation must only be taken into account after a patient and prescriber have discussed all treatment options and only if they have no preference about which medicine they want to use.

    Anticoagulants can only be initiated by clinicians/practitioners who have the necessary skills and experience in line with Local commissioning arrangements. 
    Link  UKMI Q&A: IM injections in warfarin patients
    Link  UKMI Q&A: Is there an interaction between warfarin and proton pump inhibitors
       
    Acenocoumarol (Sinthrome®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber

     
       
    Apixaban
    (2.5mg tabs: £57.00/60 5mg tabs: £53.20/56)
    View adult BNF View SPC online View childrens BNF
    Formulary APC preferred agent: this recommendation must only be taken into account after a patient and prescriber have discussed all treatment options (including warfarin) and only if they have no preference about which medicine they want to use.

    Amber Traffic Light  Following diagnosis of AF- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD. RICaD: Apixaban in AF

    Red Traffic Light  Use following Hip and Knee surgery- full course of treatment supplied on discharge.

    Amber Traffic Light  For the treatment and secondary prevention of DVT and/or PE - use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD.
    RICaD: Apixaban in DVT/ PE
     
    Link  NICE TA245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults
    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
       
    Rivaroxaban (Restricted Item(2.5mg tabs:£50.40/56; 10mg tabs:£54/30; 15mg tabs:£50.40/28; 20mg tabs:£50.40/28)
    View adult BNF View SPC online View childrens BNF
    Formulary APC preferred agent: this recommendation must only be taken into account after a patient and prescriber have discussed all treatment options (including warfarin) and only if they have no preference about which medicine they want to use.


    Amber Traffic Light  Following diagnosis of AF- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD. RICaD: Rivaroxaban in AF

    Amber Traffic Light  For the treatment and secondary prevention of DVT and/or PE - use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD.
    RICaD: Rivaroxaban in DVT /PE


    Amber Traffic Light  For preventing adverse outcomes after acute management of ACS (TA335) use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD.
    RICaD: Rivaroxaban post ACS



    Red Traffic Light  Use following Hip and Knee surgery- full course of treatment supplied on discharge.  
    Link  NICE TA256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
    Link  NICE TA261: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
    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 (Mar 2015)
       
    Dabigatran
    (£51.00/ 60 capsules (all strengths))
    View adult BNF View SPC online View childrens BNF
    Formulary Amber Traffic Light  Following diagnosis of AF- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD. RICaD: Dabigatran in AF

    Red Traffic Light  Use following Hip and Knee surgery- full course of treatment supplied on discharge.

    Amber Traffic Light  For the treatment and secondary prevention of DVT and/or PE - use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD.
    RICaD: Dabigatran in DVT / PE

     
    Link  NICE TA157: Dabigatran etexilate for the prevention of venous thromboembolism 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 (Restricted Item)
    (£51.80 /28 tablets regardless of strength)
    View adult BNF View SPC online View childrens BNF
    Formulary Amber Traffic Light For treating and for preventing recurrent DVT and PE- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD
    RICaD: Edoxaban in DVT/PE


    Amber Traffic Light  Following diagnosis of AF- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD
    RICaD: Edoxaban in AF
     
    Link  TA354: Edoxaban for treating and preventing DVT and/or PE
    Link  TA355: Edoxaban for preventing stroke and systemic embolism in people with atrial fibrillation
       
    Phenindione tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    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
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    02.09  Antiplatelet drugs to top
    Aspirin (antiplatelet)  (Dispersible)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
    Link  UKMI Q&A: Is there evidence to support the use of EC coated aspirin to reduce GI side effects?
       
    Clopidogrel 75mg tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Dipyridamole MR capsules (Persantin® Retard)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Dipyridamole tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Prasugrel (Efient®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
    Link  NICE TA317: Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes
       
    Ticagrelor (Brilique®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber

    Use in ACS,

    The need for a RICaD has been removed (February 2018) following discussion at the APC. Rationale: clinicians are familiar with this drug for this indication. 

     
    Link  NICE TA236: Acute coronary syndromes - ticagrelor
       
    Ticagrelor (Brilique®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber

    In line with NICE

    Use post MI, need for RICaD removed January 2019

     
    Link  NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction
       
    Tirofiban (Aggrastat®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    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
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
  • Hospital only drug 
  • Link  NICE TA264: Ischaemic stroke (acute) - alteplase
       
    Reteplase
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
  • Hospital only 
  •    
    Streptokinase
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
  • Hospital only  
  •    
    Tenecteplase
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
  • Hospital only 
  •    
    Urokinase
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
  • Hospital only 
  •    
    02.11  Antifibrinolytic drugs and haemostatics
    Etamsylate (Dicynene®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Evicel (®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Tisseel
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Tranexamic Acid 5% mouthwash
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    Palliative use only 
       
    Tranexamic Acid 500mg tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Tranexamic Acid Injection
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Injection (Secondary Care only)

     
       
    02.11  Blood-related products to top
    Factor VIIa (Recombinant) (Eptacog alfa)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Fresh Frozen Plasma
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    Prothrombin complex injection
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    02.12  Lipid-regulating drugs
    02.12  Statins
    Atorvastatin tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Fluvastatin capsules
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    Formulary
    Amber
     
       
    Pravastatin tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Rosuvastatin tablets
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    Formulary
    Amber
     
       
    Simvastatin tablets
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    Formulary
    Green
     
       
    02.12  Bile acid sequestrants
    Colestyramine sachets
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    Formulary
    Amber

    Jaundice and Primary Biliary Cholangitis (PBC)

     
       
    02.12  Ezetimibe
    Ezetimibe (Ezetrol®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    in line with NICE 
    Link  NICE TA385: Hypercholesterolaemia - ezetimibe
       
    02.12  Fibrates to top
    Bezafibrate
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    Formulary
    Green
  • immediate release formulation
  • modified release formulation 
  •    
    Fenofibrate
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    Formulary
    Green
  • tablets
  • capsules 
  •    
    02.12  Nicotinic acid group
    02.12  Omega-3 fatty acid compounds
    02.12  PCSK9 inhibitors
    Alirocumab (Praluent®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
    To be used in line with NICE TA393 
    Link  NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
       
    Evolocumab (Repatha®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
    To be used in line with NICE TA 394 
    Link  NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
       
    02.12  Other lipid modifying agents
    02.13  Local sclerosants to top
    Sodium Tetradecyl Sulphate (Fibro-Vein®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
     ....
     Non Formulary Items
    Abciximab

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    Non Formulary
     
    Acebutolol

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    Non Formulary
     
    Acipimox  (Olbetam®)

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    Non Formulary
     
    Adrenaline / Epinephrine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Antithrombin III  (Kybemin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Aprotinin  (Trasylol®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Argatroban  (Exembol®)

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    Non Formulary
     
    Aspirin  (Flamasacard®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Aspirin (antiplatelet)  (Angettes® 75)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Aspirin (antiplatelet)  (Caprin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Aspirin (antiplatelet)  (Nu-Seals® Aspirin)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Atenolol and Co-amilozide  (Kalten®)

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    Non Formulary
     
    Atenolol and Nifedipine

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    Non Formulary
     
    Azilsartan

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    Non Formulary
     
    Bemiparin

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    Non Formulary
     
    Cangrelor

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    Non Formulary
     
    Canusal®

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    Non Formulary
     
    Captopril and Hydrochlorothiazide  (Capozide®)

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    Non Formulary
     
    Captopril and Hydrochlorothiazide  (Co-zidocapt®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Celiprolol Hydrochloride

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    Non Formulary
     
    Cilostazol  (Pletal®)

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    Non Formulary
     
    Ciprofibrate

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    Non Formulary
    Black
     
    Clopidogrel  (Grepid®)

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    Non Formulary
     
    Clopidogrel 300mg  (Plavix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Colesevelam  (Cholestagel®)

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    Non Formulary
     
    Colestipol  (Colestid®)

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    Non Formulary
     
    Colestyramine  (Questran®)

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    Non Formulary
     
    Colestyramine  (Questran® Light)

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    Non Formulary
     
    Co-tenidone (atenolol and chlortalidone)

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    Non Formulary
     
    Dalteparin

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    Non Formulary
     
    Dipyridamole and Aspirin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    Discontinued
     
    Dipyridamole injection  (Persantin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dopamine Hydrochloride  (Select-A-jet® Dopamine)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dopexamine

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    Non Formulary
     
    Dopexamine  (Dopacard®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Drotrecogin Alfa (Activated)  (Xigris®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Enalapril and Hydrochlorothiazide  (Innozide®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Eprosartan  (Teveten®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Eptifibatide  (Integrilin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Ethanolamine Oleate

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Factor IX Fraction, Dried

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Factor VIII Fraction, Dried

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Factor VIII Inhibitor Bypassing Fraction

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Factor XIII Fraction, Dried

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fluvastatin M/R  (Lescol® XL)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Fosinopril

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Gemifibrozil

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Gemifibrozil  (Lopid®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Guanethidine Monosulphate

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Heparin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Hepsal®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Hydralazine Hydrochloride  (Apresoline®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Iloprost injection

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Indapamide  (Natrilix-SR®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Indoramin  (Doralese®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Inositol Nicotinate  (Hexopal®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Isradipine  (Prescal®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Lepirudin

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    Non Formulary
     
    Lercanidipine

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    Non Formulary
     
    Lisinopril and Hydrochlorothiazide  (Carace® Plus)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Lisinopril and Hydrochlorothiazide  (Lisicostad®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Lisinopril and Hydrochlorothiazide  (Zestoretic®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Lomitapide  (Lojuxta®▼)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Mexiletine 167mg hard capsules  (Namuscla®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black

    £££

    Namuscla® brand of mexiletine is not licensed for treatment of ventricular arrhythmia

     

     
    Moexipril  (Perdix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Moracizine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Moxisylyte  (Opilon®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Nadolol  (Corgard®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    • 80mg tablets only
     
    Naftidrofuryl Oxalate  (Praxilene®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Nebivolol  (Nebilet®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Nicotinic Acid

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Nicotinic acid/ laropiprant  (Tredaptive ®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Omega-3-Acid Ethyl Esters  (Omacor®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    Link  Patient Information Leaflet
    Link  UKMI Q&A: Review of evidence for dyslexia
     
    Omega-3-Marine Triglycerides  (Maxepa®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • In line with NHS England's Guidance for CCGs: Items which should not routinely be prescribed in primary care (Dec 2017)

    Click here to access guidance
  • Link  Patient Information Leaflet
     
    Oxerutins  (Paroven®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oxprenolol Hydrochloride

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oxprenolol Hydrochloride and Cyclopenthiazide  (Trasidrex®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Pentoxifylline  (Trental®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Perindopril Arginine  (Coversyl® Arginine)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • In line with NHS England's Guidance for CCGs: Items which should not routinely be prescribed in primary care (Dec 2017)

    Click here to access guidance
  • Link  Patient Information Leaflet
     
    Phentolamine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Pindolol

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Pindolol and Clopamide  (Viskaldix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Pravastatin Sodium  (Lipostat®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Prazosin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Procainamide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Protein C Concentrate  (Ceprotin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Quinapril and Hydrochlorothiazide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Ramipril and Felodipine  (Triapin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sevikar HCT®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Simvastatin  (Zocor®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Simvastatin and Ezetimibe  (Inegy®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sitaxentan Sodium  (Thelin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Telmisartan

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Terazosin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Timolol

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Timolol Maleate and Bendroflumethiazide  (Prestim®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Tolazoline

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Torasemide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Trandolapril  (Gopten®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Trandolapril and Verapamil  (Tarka®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Tranexamic Acid  (Cyklokapron®)

    View adult BNF View SPC online View childrens BNF
    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
    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

    Prescribing in children

    The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.

    The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.

      

    Green

    Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications.  

    Amber

    Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate, or initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.

    Some amber medicines require agreement with the local (internal) medicines committee prior to initiation; others may require a framework to support safe transfer and maintenance of care such as a RICaD or ESCA. The Formulary will be annotated to reflect these requirements.   

    Red

    Medicines for initiation and maintenance prescribing by Specialists only  

    Black

    Non-formulary medicines- medicines not recommended for routine primary care prescribing.  

    Grey

    Positive NICE TA and /or awaiting local clarification on place in therapy ; Please contact your Medicines Optimisation team for more information.  

    netFormulary