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2. Cardiovascular System

The following local guidance is available for cardiovascular disease: 

Area Prescribing Committee website

CDDFT Intranet

Guideline for lipid modification in primary and secondary prevention of CVD:

Area Prescribing Committee website

CDDFT Intranet

FATS7 - A strategy for the use of cholesterol lowering drugs across the North East and North Cumbria

Antiplatelet Drugs – Guidance for the use in Primary Care & NECVN Network Guidelines for Antiplatelet Use in STEMI, NSTEMI & Unstable Angina

Area Prescribing Committee website

CDDFT Intranet

Hypertension Guidelines (based upon NICE CG127)

Area Prescribing Committee website

Stroke Risk Stratification & Thromboprophylaxis Guideline

Area Prescribing Committee website

CDDFT Intranet

County Durham and Darlington DVT Pathway:

County Durham and Darlington DVT Pathway Information

Important Update to the County Durham and Darlington DVT Pathway

County Durham Darlington DVT Investigation Proforma -Rivaroxaban

County Durham Darlington DVT Investigation  Proforma -Enoxaparin

NICE CG172: MI – Secondary Prevention

Other NICE Cardiovascular Guidelines are available via this link

CD&D APC Patient Decision Aids Resource available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/

CD&D APC “Do Not Prescribe List” and “Grey List – drugs prescribed under limited circumstances” available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/

Digoxin
BNF | BNFC | SPC

Tablets - 62.5microgram, 125microgram, 250microgram 

Elixir - 50microgram/ml 

 

Digoxin-specific antibody
BNF | BNFC | SPC

Vials containing 38mg digoxin-specific antibody fragments (Fab) for administration by IV infusion

See toxbase for drug protocol

Digoxin Injection
BNF | BNFC | SPC

Drug Protocol – digoxin loading dose (CDDFT intranet access only)

Milrinone
BNF | BNFC | SPC

10mg in 10ml injection

Please note – metolazone has been discontinued in the UK and as such has been removed from the formulary.  Please see advice from the British Society for Heart Failure which recommends bendroflumethiazide as the most suitable alternative.

Bendroflumethiazide
BNF | BNFC | SPC

Tablets - 2.5mg, 5mg 

Indapamide
BNF | BNFC | SPC

Tablets - 2.5mg 

For indapamide use standard release only (not modified release)

Chlortalidone
BNF | BNFC | SPC
Furosemide
BNF | BNFC | SPC

Tablets - 20mg, 40mg, 

Oral Solution - 20mg/5ml, 40mg/5ml, 50mg/5ml 

20mg in 2ml, 50mg in 5ml & 250mg in 25ml injections

Drug protocols: (CDDFT intranet access only)

IV Furosemide in the community

IV Furosemide infusion

Bumetanide
BNF | BNFC | SPC

1mg & 5mg tablets
1mg in 5ml sugar-free solution
2mg in 4ml injection

Amiloride
BNF | BNFC | SPC

Tablets - 5mg 

Oral Solution - 5mg/5ml 

Spironolactone
BNF | BNFC | SPC

Tablets -  25mg, 50mg, 100mg 

Suspension -  5mg/5ml, 10mg/5ml, 25mg/5ml, 50mg/5ml and 100mg/5ml u

Prescribe Oral Solution as Rosemont brand 

Notes: post-acute myocardial infarction patients and patients with heart failure treatment should be initiated on instructions from a cardiologist or GP with a specialist interest in cardiology.  Spironolactone is first choice (ahead of eplerenone) for severe heart failure.

MHRA Drug Safety Update (Feb 2016): Spironolactone and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia

MHRA Drug Safety Update (Dec 2016): Spironolactone and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia—clarification, December 2016

 

 

Eplerenone
BNF | BNFC | SPC

25mg & 50mg tablets

Indication: to reduce the risk of cardiovascular mortality and morbidity in stable patients with left ventricular dysfunction and clinical evidence of heart failure after myocardial infarction, usually initiated on day 4 or 5 post-acute MI.
Notes: Eplerenone may have a place in those patients unable to tolerate spironolactone (due to gynaecomastia or nausea).
Restrictions: treatment should only be initiated on instructions from a consultant cardiologist or a GP with a specialist interest in cardiology.

The use of combination diuretics is not recommended.

Hydrochlorothiazide
BNF | BNFC | SPC

Only available in combination with other formulary drugs e.g. co-amilozide

Mannitol
BNF | BNFC | SPC

10% & 20% intravenous infusions

Adenosine
BNF | BNFC | SPC

6mg in 2ml injection, 25mg in 5ml injectionu

Digoxin
BNF | BNFC | SPC

see section 2.1.1

Amiodarone
BNF | BNFC | SPC

Tablets - 100mg, 200mg 

Initiated and titrated to maintenance dose only under specialist supervision

Drug protocols: Amiodarone IV and oral (CDDFT intranet access only)

Patient information leaflet (CDDFT intranet access only)

Dronedarone
BNF | BNFC | SPC

NICE TA197

400mg tablets

As recommended by NICE approved for patients who are unsuitable for or not tolerant of amiodarone. Treatment is to be initiated by cardiologists. 

Disopyramide
BNF | BNFC | SPC

Tablets - 100mg, 150mg 

Initiated and titrated to maintenance dose only under specialist supervision

Flecainide
BNF | BNFC | SPC

Tablets- 50mg, 100mg 

MR Capsules - 200mg 

Initiated and titrated to maintenance dose only under specialist supervision

Flecainide IV: CDDFT Drug Protocol

Propafenone
BNF | BNFC | SPC

Tablets - 150mg, 300mg 

Initiated and titrated to maintenance dose only under specialist supervision

Ajmaline
BNF | BNFC | SPC

50mg in 10ml injection

Ajamaline: CDDFT Drug Protocol

Procainamide
BNF | BNFC | SPC

1g in 10ml injection

Lidocaine
BNF | BNFC | SPC

100mg injection, pre-filled syringes
1mg/ml (0.1%) & 2mg/ml (0.2%) IV infusions 500ml)

Magnesium Sulphate Injection
BNF | BNFC | SPC

Drug protocol: magnesium sulphate infusion (CDDFT intranet access only)

First Choice

Bisoprolol - Cardioselective

Propranolol - non-cardioselective

Alternatives

Atenolol

Meteoprolol - metoprolol indication: for less stable patients

Labetalol - for the management of hypertension in pregnancy

Carvedilol - for use in the treatment of heart failure only

Sotalol

Bisoprolol
BNF | BNFC | SPC

Tablets - 1.25mg, 2.5mg, 3.75mg, 5mg, 7.5mg, 10mg 

Propranolol
BNF | BNFC | SPC

Tablets - 10mg, 40mg, 80mg, 160mg 

Oral Solution - 5mg/5ml, 10mg/5ml, 40mg/5ml, 50mg/5ml 

Non-cardioselective

Propranolol indication: for migraine prophylaxis and to control somatic symptoms associated with anxiety

Drug protocol: paediatric oral propranolol in haemangioma (CDDFT intranet access only)

Atenolol
BNF | BNFC | SPC

Tablets - 25mg, 50mg, 100mg 

Syrup - 25mg/5ml 

Carvedilol
BNF | BNFC | SPC

Tablets - 3.125mg 6.25mg, 12.5mg, 25mg 

Carvedilol indication: for use in the treatment of heart failure only

Labetalol
BNF | BNFC | SPC

50mg, 100mg & 200mg tablets

Labetalol indication: for the management of hypertension in pregnancy

Metoprolol
BNF | BNFC | SPC

Tablets - 50mg 

Liquid - 50mg/5ml

Metoprolol indication: for less-stable patients

Sotalol
BNF | BNFC | SPC

Tablets - 40mg, 80mg, 160mg 

 

Hydralazine
BNF | BNFC | SPC

Tablets - 25mg 

Hydralazine restriction: usually hospital initiation

Minoxidil
BNF | BNFC | SPC

5mg & 10mg tablets
Treatment should only be on the advice of a cardiologist/ nephrologist.

Diazoxide
BNF | BNFC | SPC

300mg in 20ml injection

Methyldopa
BNF | BNFC | SPC

Tablets - 125mg, 250mg, 500mg 

Moxonidine
BNF | BNFC | SPC

200, 300 & 400 microgram tablets

Clonidine
BNF | BNFC | SPC

100 microgram tablets

Doxazosin
BNF | BNFC | SPC

Tablets - 1mg, 2mg, 4mg 

Standard release tablets only not MR

Phenoxybenzamine
BNF | BNFC | SPC

10mg capsules; 100mg in 2ml injection

Phentolamine
BNF | BNFC | SPC

10mg in 1ml injection

MHRA Drug Safety Update (June 2014):  Combination use of medicines from different classes of renin-angiotensin system blocking agents: risk of hyperkalaemia, hypotension, and impaired renal function—new warnings

MHRA Drug Safety Update (June 2014):  Combination use of medicines from different classes of renin-angiotensin system blocking agents: risk of hyperkalaemia, hypotension, and impaired renal function—new warnings

Lisinopril
BNF | BNFC | SPC

Tablets - 2.5mg, 5mg, 10mg, 20mg 

Ramipril
BNF | BNFC | SPC

Capsules - 1.25, 2.5mg, 5mg, 10mg 

Ramipril dosage form restriction: use capsules – do not use tablets

Perindopril
BNF | BNFC | SPC

Tablets - 2.5mg, 5mg, 10mg 

Perindopril arginine
BNF | BNFC | SPC
Captopril
BNF | BNFC | SPC

2mg capsules u and 5mg in 5ml (1mg/ml) oral suspension u
– treatment should only be on the advice of a hospital
paediatrician.

Second line in patients who have tried and were unable to tolerate at least two ACE inhibitors. 

Candesartan
BNF | BNFC | SPC

Tablets - 2mg, 4mg, 8mg, 16mg, 32mg 

For use in Heart failure

Losartan
BNF | BNFC | SPC

Tablets - 12.5mg, 25mg, 50mg, 100mg 

Oral Suspension - 12.5mg/5ml 

Sacubitril/Valsartan▼
BNF | BNFC | SPC
Aliskiren
BNF | BNFC | SPC

MHRA Drug Safety Update (June 2014):  Combination use of medicines from different classes of renin-angiotensin system blocking agents: risk of hyperkalaemia, hypotension, and impaired renal function—new warnings

Pulmonary Arterial Hypertension – specialist centres only (Freeman, Newcastle)

Bosentan
BNF | BNFC | SPC

62.5mg & 125mg tablets

NHS England – Not Routinely Commissioned for digital ulcers

Commissioner: NHS England - Policy - A11/P/a & A11/PS/b

Ambrisentan
BNF | BNFC | SPC

10mg tablets

Commissioner: NHS England - Policy - A11/P/a & A11/PS/b

Sildenafil
BNF | BNFC | SPC

20mg tablets (Revatio®)
25mg, 50mg and 100mg tablets u

Commissioner: NHS England - Policy - A11/P/a & A11/PS/b

Iloprost
BNF | BNFC | SPC

50 microgram in 0.5ml & 100 microgram in 1ml inj u
10 microgram in 1ml and 20 microgram in 2ml nebules

Commissioner: NHS England - Policy - A11/PS/b

Glyceryl Trinitrate
BNF | BNFC | SPC

Aerosol Spray - 400micrograms/metered dose 

Isosorbide Mononitrate
BNF | BNFC | SPC

Tablets  - 10mg, 20mg, 40mg 

Dosage form restriction: avoid using modified release or patch preparations. Standard release isosorbide mononitrate should be prescribed using twice daily asymmetric dosing (e.g. 8am & 4pm)

Glyceryl Trinitrate Injection
BNF | BNFC | SPC

5mg in 5ml , 50mg in 10ml & 50mg in 50ml injections

Glyceryl Trinitrate IV Infusion: CDDFT Drug Protocol

Amlodipine
BNF | BNFC | SPC

Tablets- 5mg, 10mg 

Notes: if a 10mg dose is not tolerated e.g. due to leg/ankle oedema, consider reducing dose before changing to an alternative such as lercanidipine

Hypertension Guidelines (based upon NICE CG127) Primary Care Website

Diltiazem
BNF | BNFC | SPC

MR Tablets - 60mg 

MR Tablets/Capsules (BD preparations) - 90mg, 120mg, 180mg

MR Tablets/Capsules (OD preparations) - 120mg, 180mg, 240mg, 300mg, 360mg.

 

Different versions of modified release diltiazem containing more than 60mg may not have the same clinical effect. Specify brand to avoid confusion

Brand – Viazem XL is the Formulary brand of choice for starting new patients on long acting diltiazem

Lercanidipine
BNF | BNFC | SPC

Tablets - 10mg, 20mg 

Indication: for use as a 2nd line calcium channel blocker where amlodipine is not tolerated

Nifedipine
BNF | BNFC | SPC

Once Daily formulations (Preferred)
20mg controlled release tablets (Adalat LA), 30mg &
60mg m/r capsules (Coracten XL)
Other Formulations
5mg & 10mg capsules
10mg & 20mg retard tablets
20mg per ml (1mg/drop) dropsu

Nifedipine Modified Release Brand: Coracten XL is the once daily brand of choice

Nimodipine
BNF | BNFC | SPC

30mg tablets 
10mg in 50ml (200 micrograms/ml) for IV infusion

Nimodipine indication: only for the prevention of vascular spasm following subarachnoid haemorrhage

Verapamil
BNF | BNFC | SPC

Tablets - 40mg, 80mg, 120mg, 160mg

MR Tablets - 240mg

Oral Solution - 40mg/5ml

Verapamil indication: arrhythmias or angina

 

Nicorandil
BNF | BNFC | SPC

Tablets - 10mg, 20mg 

MHRA Drug Safety Update (Jan 2016): Nicorandil (Ikorel): now second-line treatment for angina - risk of ulcer complications

Ivabradine▼
BNF | BNFC | SPC

Tablets - 5mg, 7.5mg 

 

Indication: for symptomatic treatment of chronic stable angina pectoris in patients with normal sinus rhythm for whom heart rate control is desirable and who have a contra-indication or intolerance for beta-blockers and rate-limiting calcium-channel blockers.

Restrictions: for initiation on advice from consultant cardiologists in patients with contra-indications to or intolerance of standard therapy

MHRA Drug Safety Update (Dec 2014): Ivabradine (Procoralan) in the symptomatic treatment of angina: risk of cardiac side effects

Ranolazine
BNF | BNFC | SPC

375mg, 500mg and 750mg prolonged release tablets.

Indication: the treatment of angina which cannot be treated satisfactorily using standard antianginal drugs and / or revascularisation.
Restriction: To be initiated and titrated by consultant cardiologists and only suitable for primary care prescribing once treatment is stabilised and a benefit is seen.

Naftidrofuryl oxalate
BNF | BNFC | SPC

100mg capsules

In Raynaud’s phenomenon some patients may require treatment with a vasodilator. Nifedipine may be of use, especially in primary Raynaud’s syndrome.

NICE TA223

Cilostazol▼
BNF | BNFC | SPC
Inositol Nicontinate
BNF | BNFC | SPC
Oxerutins
BNF | BNFC | SPC
Moisylyte
BNF | BNFC | SPC
Pentoxifylline
BNF | BNFC | SPC
Enoxaparin
BNF | BNFC | SPC

2,000 IU (20 mg)/0.2 ml solution for injection in pre-filled syringe
4,000 IU (40 mg)/0.4 ml solution for injection in pre-filled syringe
6,000 IU (60 mg)/0.6 ml solution for injection in pre-filled syringe
8,000 IU (80 mg)/0.8 ml solution for injection in pre-filled syringe
10,000 IU (100 mg)/1 ml solution for injection in pre-filled syringe

12,000 IU (120 mg)/0.8 ml solution for injection in pre-filled syringe
15,000 IU (150 mg)/1 ml solution for injection in [pre-filled syringe

See Letter Sent to Healthcare Professionals (June 2017) - Clexane (enoxaparin sodium): updates to strength expression, dose regimens in DVT/PE, use in patients with severe renal impairment

 

 

Heparin Sodium
BNF | BNFC | SPC

50 units in 5ml & 200 units in 2ml – for flushing cannulae

Drug protocol: heparin in general medicine (CDDFT intranet access only)

Drug protocol: Unfractionated Heparin (treatment dose) for use in Vascular Surgery (CDDFT intranet access only)

Fondaparinux
BNF | BNFC | SPC

1.5mg in 0.3ml injection, 2.5mg in 0.5ml injection,
5mg in 0.4ml injection, 7.5mg in 0.6ml injection &
10mg in 0.8ml injection in pre-filled syringes

Fondaparinux indication: for the treatment of unstable angina or non ST-elevation myocardial infarction.  CDDFT Drug Protocol

Danaparoid
BNF | BNFC | SPC

750 units in 0.6ml injection (1,250 units/ml)

Danaparoid notes: for use on specific advice from haematologists in patients who develop thrombocytopaenia with heparins - cross reactivity with heparin antibodies is probably <10%

Epoprostenol
BNF | BNFC | SPC

Epoprostenol (as sodium salt) 500 microgram & 1.5mg injection injection (Folan®)

Epoprostenol (as sodium) 500 microgram & 1.5mg injection injection (Veletri®)

CAUTION TWO BRANDS AVAILABLE

Epoprostenol PVD CDDFT Drug Protocol

Commissioner: NHS England - Policy - A11/PS/b

See Letter Sent to Healthcare Professionals (Sept 2016):

Flolan® (epoprostenol) – Introduction of new sterile solvent with different pH; temporary availability of two different formulations.

See Letter Sent to Healthcare Professionals (April 2017) - Floran (epoprostenol): reminder of replacement of Flolan (with Solvent pH 10.5) with Flolan (with Solvent pH 12)

 

Iloprost
BNF | BNFC | SPC

50 microgram in 0.5ml & 100 microgram in 1ml injectionsu

Unlicensed

Stroke Risk Stratification & Thromboprophylaxis Guideline

Primary Care Website or CDDFT Intranet

County Durham and Darlington DVT Pathway Information

Important Update to the County Durham and Darlington

DVT Pathway

County Durham Darlington DVT Investigation Proforma -Rivaroxaban

County Durham Darlington DVT Investigation  Proforma -Enoxaparin

MHRA Warning: Risk of serious haemorrhage with dabigatran, rivaroxaban & apixiban

Warfarin
BNF | BNFC | SPC

Tablets - 500micrograms(white), 1mg (brown), 3mg(blue), 5mg(pink) 

Warfarin and Rivaroxaban are First line choices for anticoagulation

CDDFT Intranet Oral anticoagulation with warfarin - adult patient management guidelines (including bleeding with NOACs)

MHRA Drug Safety Update (July 2016): Warfarin: reports of calciphylaxis

Rivaroxaban▼
BNF | BNFC | SPC

Tablets - 10mg, 15mg 

Warfarin and Rivaroxaban are First line choices for anticoagulation

MHRA Drug Safety Update (Oct 2013): Risk of serious haemorrhage with dabigatran, rivaroxaban & apixiban

Indication: in the treatment of AF and DVT where patients can’t tolerate other treatment options and also in the fast track DVT pathway

NICE Guidance: NICE TA261, NICE TA256, NICE TA170, NICE TA335

NOT RECOMMENDED: The Northern (NHS) Treatment Advisory Group does not recommend Rivaroxaban (Xarelto®▼) for acute coronary syndromes.

 

Apixaban
BNF | BNFC | SPC

Tablets - 2.5mg, 5mg 

When Rivaroxaban unsuitable for individual patient following shared decision discussion

NICE Guidance: NICE TA275, NICE TA341

Dabigatran
BNF | BNFC | SPC

Tablets - 75mg, 110mg and 150mg 

When Rivaroxaban unsuitable for individual patient following shared decision discussion

Approved indication: for prevention of stroke in non-valvular atrial fibrillation

NICE Guidance: NICE TA249, NICE TA157, NICE TA327

MHRA Drug Safety Update (March 2013): Dabigatran - contraindicated in patients with prosthetic heart valve(s) requiring anti-coagulant treatment, because of the risk of thrombosis and haemorrhage

MHRA Drug Safety Update (Oct 2013): Risk of serious haemorrhage with dabigatran, rivaroxaban & apixiban

Edoxaban▼
BNF | BNFC | SPC

Tablets - 15mg 

When Rivaroxaban unsuitable for individual patient following shared decision discussion

NICE Guidance: NICE TA355, NICE TA354

Phenindione
BNF | BNFC | SPC

10mg and 25mg tablets

Protamine Sulphate
BNF | BNFC | SPC

50mg in 5ml injection

Idarucizumab▼
BNF | BNFC | SPC

2.5g/50ml solution for injection/infusion

Antiplatelet Drugs – Guidance for the use in Primary Care & NECVN Network Guidelines for Antiplatelet Use in STEMI, NSTEMI & Unstable Angina

Primary Care Website or CDDFT Intranet

NICE CG172: MI – Secondary Prevention

Aspirin
BNF | BNFC | SPC

Tablets - 75mg 

Aspirin dosage form restrictions: ONLY plain tablets. e/c tablets are not recommended for use.

Clopidogrel
BNF | BNFC | SPC

Tablets - 75mg, 300mg 

Clopidogrel: the APC recommends the use of generic 75mg clopidogrel tablets in all the approved indications for clopidogrel

300mg tablets also available for use in giving loading dose prior to percutaneous coronary interventions (PCI)

NICE TA210

MHRA Drug Safety Update (December 2013): Clopidogrel - risk of acquired haemophilia with clopidogrel

 

Prasugrel
BNF | BNFC | SPC

Tablets - 5mg, 10mg 

Prasugrel: NICE TA317 (review of TA182)

MHRA Drug Safety Update (January 2014): increased risk of bleeding – advice around timing of loading dose for prasugrel

 

Ticagrelor
BNF | BNFC | SPC

90mg tablets

Ticagrelor: NICE TA236, NICE TA420

Dipyridamole MR
BNF | BNFC | SPC

200mg m/r capsules

Dipyridamole indication: as per guideline and NICE TA210

Tirofiban
BNF | BNFC | SPC

12.5mg in 250ml infusions, 12.5mg in 50ml (250 microgram/ml) vials for preparing infusions

Tranexamic Acid
BNF | BNFC | SPC

Tablets - 500mg 

Beriplex P/N
BNF | BNFC | SPC

Prothrombin complex concentrate

For use in reversing the effects of oral anticoagulants in patients with life or limb threatening bleeding in accordance with a regional protocol – see CDDFT Intranet Oral anticoagulation with warfarin - adult patient management guidelines (including bleeding with NOACs)

Commissioner: NHS England - BCSH Guidelines

Antithrombin III
BNF | BNFC | SPC
Factor IX
BNF | BNFC | SPC
Factor VII
BNF | BNFC | SPC
Factor VIIa
BNF | BNFC | SPC
Factor VIII
BNF | BNFC | SPC
Factor VIII Inhibitor Bypassing Factor
BNF | BNFC | SPC
Factor XIII
BNF | BNFC | SPC
Fibrinogen
BNF | BNFC | SPC
Tranexamic Acid Injection
BNF | BNFC | SPC

IV Tranexamic Acid in trauma CDDFT Drug Protocol

Etamasylate
BNF | BNFC | SPC

Guideline for lipid modification in primary and secondary prevention of CVD:

Primary Care Website or CDDFT Intranet

NICE CG172: MI – Secondary Prevention

FATS7 - A strategy for the use of cholesterol lowering drugs across the North East and North Cumbria

An MHRA (May 2014)  summary of the risks and benefits of statins can be found here

Simvastatin and Ezetimibe Combination product
BNF | BNFC | SPC
Atorvastatin
BNF | BNFC | SPC

Tablets - 10mg, 20mg, 40mg, 80mg 

Simvastatin
BNF | BNFC | SPC

Tablets - 10mg, 20mg, 40mg, 80mg 

Tablets May be crushed and administered immediately in water

Pravastatin
BNF | BNFC | SPC

Tablets - 10mg, 20mg, 40mg 

 

Rosuvastatin
BNF | BNFC | SPC

5mg, 10mg, 20mg & 40mg tablets

CD&D APC Grey List: Only to be considered as an option when patient has proven intolerance to, or lack of desired result from simvastatin, pravastatin and atorvastatin and in accordance with County Durham and Darlington PCTs Lipid Modification Guidelines OR as per FATS Guidelines.

Atorvastatin Chewable
BNF | BNFC | SPC

10mg and 20mg chewable tablets

More cost effective than simvastatin or atorvastatin liquid. For use in patients with swallowing difficulties needed a statin. 

Ezetimibe
BNF | BNFC | SPC

Tablets - 10mg 

Ezetimibe restrictions: see guideline

NICE guidance: NICE TA385

Guideline for lipid modification in primary and secondary prevention of CVD:

Primary Care Website

CDDFT Intranet

Colestyramine (Cholestyramine)
BNF | BNFC | SPC

4g/Sachet

Fenofibrate
BNF | BNFC | SPC

67mg, 200mg & 267mg capsules

Bezafibrate
BNF | BNFC | SPC

Tablets - 200mg 

Omega-3
BNF | BNFC | SPC

1g capsules

CD&D APC Grey List: Omega-3-fatty acids (e.g. Omacor) should only be used for the treatment of hypertriglyceridaemia under the care of a lipid management specialist, all patients receiving this medication, other than for hypertriglyceridaemia under a lipid management specialist, should have the medication discontinued.

See also NICE CG172 “do not do recommendation

Nicotinic acid and laropiprant
BNF | BNFC | SPC

The product is being withdrawn throughout the EU after a study has shown a failure to reduce major vascular events and an increase in non-fatal serious adverse events

Alirocumab▼
BNF | BNFC | SPC

75mg/1ml & 150mg/1ml solution for injection in prefilled pen

NICE TA393

See also NTAG recommendation

Evolocumab▼
BNF | BNFC | SPC

140mg/1ml solution for injection in pre-filled syringe

NICE TA394

See also NTAG recommendation

Sodium Tetradecyl Sulphate
BNF | BNFC | SPC

0.2%, 5ml; 1%, 2ml & 3%, 2ml & 5ml injections

Ethanolamine Oleate
BNF | BNFC | SPC

5% injection – 5ml

N.B. Primary Percutaneous Coronary Intervention (PCI) is now preferred to thrombolysis in patients with myocardial infarction with ST segment elevation (STEMI)

NICE TA52

Tenecteplase
BNF | BNFC | SPC

Tenecteplase indication: PE, Acute MI

Alteplase
BNF | BNFC | SPC

Alteplase indication: Acute Ischaemic Stroke NICE TA264

Drug protocol: alteplase (CDDFT intranet access only)

Urokinase
BNF | BNFC | SPC

Urokinase indication: for occluded catheters and cannulas

Dobutamine
BNF | BNFC | SPC

250mg in 20ml injection
250mg in 50ml injection

Dobutamine: CDDFT Drug Protocol

Dopamine
BNF | BNFC | SPC

200mg in 5ml injection

Dopamine: CDDFT Drug Protocol

Isoprenaline
BNF | BNFC | SPC

100 microgram in 2ml injection, 2mg in 2ml injectionu

Isoprenaline: CDDFT Drug Protocols

Dopexamine
BNF | BNFC | SPC

50mg in 5ml injection

Noradrenaline (Norepinephrine)
BNF | BNFC | SPC

2mg in 2ml & 4mg in 4ml (1 in 1,000) injections

See Letter Sent to Healthcare Professionals (March 2016): Noradrenaline (Norepinephrine) 0.08 mg/ml (4 mg in 50 mil solution for infusion in a vial with potential risk of medication errors

Ephedrine
BNF | BNFC | SPC

30mg in 1ml injection

Metaraminol
BNF | BNFC | SPC

10mg in 1ml injectionu

Phenylephrine
BNF | BNFC | SPC

10mg in 1ml injection & 3000mcg in 30ml syringe

Midodrine
BNF | BNFC | SPC

2.5mg & 5mg tablets

For limited specialist use in treating symptomatic hypotension that has not responded to conventional therapies.

Adrenaline (Epinephrine)
BNF | BNFC | SPC

1 in 1,000 injections in 1ml syringes and 1ml & 10ml ampoules
1 in 10,000 injections in 1ml & 10ml ampoules & syringes