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Birmingham, Sandwell, Solihull and environs APC Formulary
Maintained by Midlands and Lancashire Commissioning Support Unit
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.08.02  Expand sub section  Oral anticoagulants
Warfarin tablets
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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®)
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Formulary
Amber

 
   
Apixaban
(2.5mg tabs: £57.00/60 5mg tabs: £53.20/56)
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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)
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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))
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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)
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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
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Formulary
Amber
 
   
02.08.02  Expand sub section  Stroke prevention in AF
02.08.02  Expand sub section  Atrial Fibrillation
02.08.02  Expand sub section  VTE treatment
02.08.02  Expand sub section  VTE prophylaxis in hip/knee surgery to top
02.08.02  Expand sub section  VTE Prophylaxis
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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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.  

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