| Formulary Chapter 2: Cardiovascular system - Full Chapter
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| Chapter Links... |
 NICE CG107: Hypertension in pregnancy: diagnosis and management |
| NICE CG108: Chronic heart failure in adults: management |
| NICE CG126: Stable angina: management |
| NICE CG127: Hypertension in adults: diagnosis and management |
| NICE CG180: Atrial fibrillation: management |
| NICE CG68: Stroke and transient ischaemic attack in over 16s: diagnosis and initial management |
| NICE NG185; Acute coronary syndromes |
| Details... |
| 02.08 |
Anticoagulants and protamine |
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Acenocoumarol (Sinthrome®)
(Tablets)
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Formulary
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Use on the advice of a specialist only
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Edoxaban
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Formulary
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NICE TA354: Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism
NICE TA355: Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation
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Apixaban
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Formulary
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NICE Patient Decision Aid: Atrial Fibrillation: medicines to help reduce your risk of a stroke - what are the options?
NICE TA245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults
NICE TA275: Stroke and systemic embolism (prevention, non-valvular atrial fibrillation)
NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
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Dabigatran
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Formulary
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NICE Patient Decision Aid: Atrial Fibrillation: medicines to help reduce your risk of a stroke - what are the options?
NICE TA157: Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults
NICE TA249: Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation
NICE TA327: Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
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Andexanet
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Formulary
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Argatroban (Exembol®)
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Formulary
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Bivalirudin (Angiox®)
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Formulary
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Danaparoid (Orgaran®)
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Formulary
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Epoprostenol (Flolan®)
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Formulary
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Fondaparinux (Arixtra®)
(Injection)
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Formulary
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Hospital Only
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Idarucizumab
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Formulary
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Lepirudin
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Formulary
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Protamine
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Formulary
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Rivaroxaban
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Formulary
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NICE Patient Decision Aid: Atrial Fibrillation: medicines to help reduce your risk of a stroke - what are the options?
NICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease
NICE TA170: Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults
NICE TA256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
NICE TA261: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
NICE TA287: Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism
NICE TA335: Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome (March 2015)
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TauroLock (TauroLock HEP 500®)
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Formulary
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Phenindione
(Tablets)
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Formulary
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Use on the advice of a specialist only
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Warfarin
(Tablets)
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Formulary
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Sandwell place
Process for continuing prescribing oral anticoagulants in Primary care-Sandwell only
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NICE Patient Decision Aid: Atrial Fibrillation: medicines to help reduce your risk of a stroke - what are the options?
UKMI Q&A: Is there an interaction between warfain and proton pump inhibitors?
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| 02.08.01 |
Parenteral anticoagulants |
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| 02.08.01 |
Heparin |
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Heparin Sodium
(Injection)
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Formulary
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| 02.08.01 |
Low molecular weight heparins |
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Dalteparin
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Formulary
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Use current Place/Trust Status and local guidelines
Sandwell
 Non formulary
Wolverhampton
Walsall
Non formulary
Dudley
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Enoxaparin
(injection)
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Formulary
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Use current Place/Trust Status and local guidelines
Sandwell
 Single use in suspected DVT
Pregnant women - see URGENT PRESCRIBING OF ENOXAPARIN IN PROPHYLYAXIS OF VENOUS THROMBOEMBOLISM (VTE) IN PREGNANCY
For all other indications
The APC's view is that on clinical grounds, the status for certain indications approved by APC should be Amber Shared Care, supported by an ESCA. These indications are:
- Deep vein thrombosis (including paediatrics)
- Pulmonary embolism (including paediatrics)
- Intolerance/unsuitable for oral anticoagulants
- Certain cancer patients
- Injectable drug users
HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED (ESCAs to be developed). This should not prevent individuals in primary care providing initial prescriptions in urgent situations e.g. pregnancy where there is a high thrombotic risk (see guidance linked below).
Wolverhampton
Walsall
Preferred brand-Inhixa and Clexane
Dudley
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Tinzaparin
(Injection)
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Formulary
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Use current Place/Trust status and local guidelines
Sandwell
Single use in suspected DVT
For all other indications
The APC's view is that on clinical grounds, the status for certain indications approved by APC should be Amber Shared Care, supported by an ESCA. These indications are:
- Deep vein thrombosis (including paediatrics)
- Pulmonary embolism (including paediatrics)
- Intolerance/unsuitable for oral anticoagulants
- Certain cancer patients
- Injectable drug users
- Pregnant women
HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED (ESCAs to be developed). This should not prevent individuals in primary care providing initial prescriptions in urgent situations e.g. pregnancy where there is a high thrombotic risk.
Wolverhampton
Walsall
Dudley
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NICE NG89: Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism
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| 02.08.01 |
Heparinoids |
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| 02.08.01 |
Hirudins |
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| 02.08.01 |
Heparin flushes |
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| 02.08.01 |
Epoprostenol |
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| 02.08.01 |
Fondaparinux |
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| 02.08.02 |
Oral anticoagulants |
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CoaguChek XS PT Test PST
(Test strips)
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Formulary
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Sandwell only -
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| 02.08.02 |
Stroke prevention in AF |
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| 02.08.02 |
Atrial Fibrillation |
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| 02.08.02 |
VTE treatment |
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| 02.08.02 |
VTE prophylaxis in hip/knee surgery |
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| 02.08.02 |
VTE Prophylaxis |
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| 02.08.03 |
Protamine sulphate |
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| .... |
| Non Formulary Items |
Bemiparin
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Non Formulary
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Burinex K®
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Non Formulary
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Canusal®
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Non Formulary
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Centyl K®
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Non Formulary
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Diumide-K Continus®
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Non Formulary
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Epoprostenol (Flolan®)
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Non Formulary
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Heparin
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Non Formulary
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Hepsal®
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Non Formulary
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Lasikal®
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Non Formulary
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Neo-NaClex-K®
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Non Formulary
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Protamine Sulphate
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Non Formulary
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Protamine Sulphate (Prosulf®)
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Non Formulary
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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Cancer Drugs Fund |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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All Settings
Suitable for initiation, ongoing prescribing, and discontinuation in both primary and secondary care settings. They are generally familiar, frequently used therapies that can be started within their licensed indications without specialist oversight. |
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Specialist only
Designated for initiation, ongoing prescribing, monitoring, exclusively by a specialists either in a hospital or as part of a specialist service (to note this could be in a non-hospital setting). Primary care should neither start nor continue these treatments except as part of a specialist service. A specialist could be either a medical or non-medical prescriber. |
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Specialist advice
Prescribers in primary care should seek advice and a recommendation from a specialists prior to initiating a medicine. Once agreed with a specialist, medicines can be initiated, prescribed and monitored in primary care without a formal shared-care agreement. |
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Specialist initiation
Medicines in this category require a specialist to start therapy, titrate dosage, and assess initial efficacy or tolerability. Once stabilised, prescribing responsibility may transfer to primary care without the need for a formal shared-care agreement. |
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Shared care agreement
Prescribing responsibility can be shared across health settings and between specialists and GPs only when formal shared care arrangement has been made. For example, there may be extensive and complex monitoring requirements or significant safety concerns (note would need a national policy on this to define the criteria for requiring a formal SCA), this will be produced once nationally. |
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Do not prescribe
Not approved for routine prescribing in primary or secondary care. For example, because they are agents classified in the BNF as “not NHS” or “Drugs of Low Clinical Value”, or they are products on NICE’s “do not do” list or NHS England’s “should not routinely prescribe” list. |
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Self Care
Not for routine prescribed in primary or secondary care unless as part of care for a long term condition. Instead, patients should be encouraged to self care with support from community pharmacy. |
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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 |
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Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry. |
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Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry. |
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Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a specialist. |
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Medicines for initiation and maintenance prescribing by Specialists (hospital or GPs with Special Interest) only |
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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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Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use. |
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