For heart failure, see The Management of Heart Failure in Primary Care. 

Secondary care use only. 

Secondary care use only. 

Restricted to neonates and paediatric patients with swallowing difficulties.

Available as an unlicensed product.

For use in secondary care by Cardiology for diuretic resistance and heart failure only.

May be more effective in patients with heart failure who are severely oedematous. See The Management of Heart Failure in Primary Care. 

• Second line for patients that cannot tolerate spironolactone (APCO November 2013).
• First line mineralocorticoid receptor antagonist for young (<65) male patients, to reduce the risk of cardiovascular mortality and morbidity in stable patients with left ventricular dysfunction and clinical evidence of heart failure after recent MI (APCO November 2017). 

Secondary care use only. 

Secondary care use only. 

For the treatment and management of non permanent atrial fibrillation in line with Shared Care Protocol and NICE TA197.

APCO January 2011.

In line with Shared Care Protocol.

APCO May 2011.

Suitable for continuation in primary care following initiation by a cardiologist.

Secondary care use only.

Suitable for continuation in primary care following initiation by a cardiologist.

Suitable for continuation in primary care following initiation by a cardiologist.

Secondary care use only.

For refractory ventricular tachycardia - restricted to EP electro physiological consultants only; and for the treatment of myotonia in patients under the care of Dr. Hilton-Jones.

Secondary care use only. 

Second line to bisoprolol for secondary prevention of coronary atery disease (e.g. post STEMI/NSTEMI).

3^rd line beta blocker option for treating heart failure, after bisoprolol and carvedilol.

APCO May 2019.

Specialist prescribing only.

Specialist prescribing only.

For use in maternity for hypertension.

Specialist prescribing only.

Specialist prescribing only.

For patients with Long QT syndrome. Licensed product now available and also on OUH  formulary.

APCO March 2020.

To control symptomatic thyrotoxicosis in hyperthyroidism.

See Management Guidelines - Thyroid Diseases.

Suitable for continuation in primary care following specialist initiation.

Use in combination with nitrate for the management of heart failure, see The Management of Heart Failure in Primary Care. 

For use by Vascular Surgery for the treatment of limb threatening ischaemia, and by Rheumatology in Raynaud's Syndrome (unlicensed).

For Pulmonary arterial hypertension. Only approved via Specialised centre at Royal Brompton. 

Funded by specialised commissioning - NHS E will not fund at OUH.

APCO May 2018.

  For continuation in primary care following specialist initiation for hypertension.

  For androgenic alopecia. Oral tablets are not licensed for this indication and the solution Regaine® is not available on the NHS (APCO July 2018). 

Secondary care use only. 

APCO March 2011.

Secondary care use only. 

Suitable for continuation in primary care following initiation by a specialist.

Specialist prescribing only.

For heart failure, see The Management of Heart Failure in Primary Care. 

Restricted for paediatric use.

Restricted to existing patients. Not to be initiated in new patients.

APCO November 2005.

For patients intolerant of ACE inhibitors due to cough.

For patients intolerant of ACE inhibitors due to cough.

For the treatment of symptomatic chronic heart failure with reduced ejection fraction in line with Shared Care Protocol.

APCO January 2017.

Report ALL suspected adverse reactions for black triangle drugs to Yellow Card Scheme.

Only for those who cannot have oral therapy.

Currently the most cost effective 60mg MR tablet is Monomil XL 60mg tablets.

Specialist prescribing only.

• Usually specialist prescribing only for arrhythmia but may be appropriate for shared care where an individual patient specific protocol is agreed (APCO January 2008).
• For patients with chronic heart failure in line with local Amber Continuation Guideline (APCO September 2018). 

As add on therapy for symptomatic treatment of patients with stable angina in line with Shared Care Protocol.

APCO March 2013.

As add on therapy for symptomatic treatment of patients with stable angina in line with Shared Care Protocol.

APCO July 2012.

For the treatment of hypertrophic cardiomyopathy and heart failure in patients who still have symptoms despite maximal dose with standard therapy.

APCO November 2013.

For the treatment of intermittent claudication as per NICE TA223.

APCO July 2011.

  For the management of osteoradionecrosis in line with Shared Care Protocol.

APCO November 2012.

  For the treatment of venous leg ulcers in line with Shared Care Protocol.

APCO November 2013.

  For gastric/liver indications.

APCO January 2014.

  For the treatment of intermittent claudication in people with peripheral arterial disease as per NICE TA223.

APCO July 2011.

Specialist prescribing only.

Specialist prescribing only.

Specialist prescribing only.

Specialist prescribing only.

Available from ‘special-order’ manufacturers or specialist importing companies.

Specialist prescribing only.

Specialist prescribing only.

Suitable for continuation in primary care following specialist initiation, in line with local amber continuation guideline.

Licensed product is now available. Limited evidence of effectiveness of midodrine and need for ongoing monitoring by the GP.

APCO July 2017.

Specialist prescribing only.

Specialist prescribing only.

For the reversal of the anticoagulant effect of dabigatran.

APCO March 2016.

Secondary care use only. 

Secondary care use only. 

In line with Dalteparin Guideline and Shared Care Protocol for Primary Care:

  For sub-therapeutic INRs, DVT in patients with cancer, IV drug users & first doses in high risk of VTE in pregnancy.

  For perioperative anticoagulation, extended thromboprophylaxis & post-partum, trauma and intermediate risk of VTE in pregnancy.

  For DVT & long haul flight prophylaxis.

APCO September 2016.

 For DVT (out of hours), in line with DVT service specification. Prescribe one off initial dose only if presentation of DVT outside of DVT clinic hours.

APCO September 2018.

 For venous thromboprophylaxis for lower limb immobilisation. 

APCO July 2017.

 First line for VTE prophylaxis in high risk covid-19 patients.

APCO January 2021.

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

  For Oxfordshire patients. Dalteparin is LMWH of choice in Oxfordshire.

APCO September 2008.

 For South East locality patients referred by Royal Berkshire Hospital Foundation Trust ONLY. In line with Royal Berkshire Hospital Foundation Trust Shared Care Protocol.

APCO January 2014.

Secondary care use only. 

For the treatment of ST-segment-elevation myocardial infarction as per NICE TA230.

Suitable for continuation in primary care following specialist initiation.

Specialist prescribing only.

Funded by specialised commissioning.

Secondary care use only. 

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

  For preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation. See Primary Care Prescriber Decision Support for DOACs in Atrial Fibrillation.

APCO January 2017.

  For treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism. See Guidelines for DOACs for Treatment and Secondary Prevention of VTE.

APCO May 2015.

 For DVT (out of hours), in line with DVT service specification. Prescribe one off initial dose only if presentation of DVT outside of DVT clinic hours.

See Guidelines for DOACs for Treatment and Secondary Prevention of VTE.

APCO September 2018.

  For preventing VTE after total hip or knee replacement in adults in line with NICE TA245.

APCO March 2012.

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

Restricted to patients who meet the following criteria:

• To be on long-term oral anticoagulation.
• To have sufficient eye sight to enable them to use the coagulometer.
• To be sufficiently dextrous to carry out self-testing. (Training may be considered for patient carers or next of kin who meet the eye sight and dexterity criteria.)
• To have GP support for the prescribing of strips.
• To already be dosed by the Oxfordshire Anticoagulation Service (JR, Churchill or Horton hospitals).
• To be able to afford the coagulometer (about £500 for the CoaguCheks and approximately £20 for enough quality control solutions for approximately one year, not including the training programme).

The patient would have to receive suitable training to carry out self-testing and this would normally be provided by the hospital anticoagulation service if self-testing is agreed appropriate.

APCO September 2018. 

  For preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation. See Primary Care Prescriber Decision Support for DOACs in Atrial Fibrillation.

APCO January 2017.

  For treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism. See Guidelines for DOACs for Treatment and Secondary Prevention of VTE.

APCO May 2015.

  For preventing VTE after total hip or knee replacement in adults in line with NICE TA157. 

APCO November 2008.

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

  For preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation. See Primary Care Prescriber Decision Support for DOACs in Atrial Fibrillation.

APCO January 2017.

  For treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism. See Guidelines for DOACs for Treatment and Secondary Prevention of VTE.

APCO January 2017.

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

  For preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation. See Primary Care Prescriber Decision Support for DOACs in Atrial Fibrillation.

APCO January 2017.

• For treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism. See Guidelines for DOACs for Treatment and Secondary Prevention of VTE (APCO May 2015).
• For preventing adverse outcomes after acute management of acute coronary syndrome in line with NICE TA335. NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page (APCO May 2015).
• For preventing atherothrombotic events in people with coronary or peripheral artery disease in combination with aspirin, as per NICE TA607 (APCO July 2020).

• For DVT (out of hours), in line with DVT service specification. Prescribe one off initial dose only if presentation of DVT outside of DVT clinic hours. See Guidelines for DOACs for Treatment and Secondary Prevention of VTE (APCO September 2018).
• For superficial thrombophlebitis, second line to dalteparin in patients at intermediate risk (APCO January 2019).

  Second line for VTE prophylaxis in high risk covid patients.

APCO January 2021.

To be initiated in primary care for atrial fibrillation in line with Shared Care Protocol.

APCO March 2017.

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

Secondary care use only. 

Secondary care use only. 

 Specialist prescribing only for Percutaneous Coronary Intervention (PCI). Funded by specialised commissioning. 

APCO September 2019.

 For reducing atherothrombotic events in people undergoing percutaneous coronary intervention or awaiting surgery requiring interruption of anti‑platelet therapy as per NICE TA351 (terminated appraisal).

APCO September 2015.

Suitable for continuation in primary care following specialist initiation for prevention of occlusive vascular events as per NICE TA210.

APCO January 2011.

Suitable for continuation in primary care following specialist initiation for prevention of occlusive vascular events as per NICE TA210.

APCO January 2011.

Suitable for continuation in primary care following specialist initiation with percutaneous coronary intervention for treating acute coronary syndromes as per NICE TA317.

NB. Treatment for up to 12 months is recommended unless stopping prasugrel is clinically indicated.

APCO May 2010.

• Suitable for continuation in primary care following specialist initiation for acute coronary syndromes as per NICE TA236, see Prescribing guidance in primary care (APCO November 2012). 
• Suitable for continuation in primary care following specialist recommendation for preventing atherothrombotic events after myocardial infarction as per NICE TA420 see Ticagrelor Amber Continuation Guideline (APCO January 2017).

Specialist prescribing only.

Specialist prescribing only.

Specialist prescribing only.

Specialist prescribing only.

First line for heavy menstrual bleeding, in line with OCCG guidelines on Heavy Menstrual Bleeding - Care Pathway and Referral Criteria. 

Funded by specialised commissioning.

Specialist prescribing only.

Funded by specialised commissioning.

Secondary care use only (haemophilia).

APCO September 2018.

Specialist prescribing only.

Funded by specialised commissioning.

Specialist prescribing only.

Funded by specialised commissioning.

Specialist prescribing only.

Funded by specialised commissioning.

Specialist prescribing only.

Funded by specialised commissioning.

Specialist prescribing only.

Funded by specialised commissioning.

Specialist prescribing only.

Funded by specialised commissioning.

Specialist prescribing only.

Funded by specialised commissioning.

Specialist prescribing only.

Funded by specialised commissioning.

For primary hypercholesterolaemia and mixed lipidaemia as per NICE TA393.

APCO July 2016.

For treating primary hypercholesterolaemia and mixed dyslipidaemia as per NICE TA394.

APCO July 2016.

See Lipid Modification Guidance. A bile acid sequestrant may be used for particular patients groups after secondary care advice oxon.diabetes_lipidsadvice@nhs.net.

See Lipid Modification Guidance. A bile acid sequestrant may be used for particular patients groups after secondary care advice oxon.diabetes_lipidsadvice@nhs.net.

Please note - due to a current manufacturing issue with colestyramine it has been agreed that clinicians can prescribe colesevelam on a temporary basis without having to seek prior approval via the OUH. Please ensure this is added to the Acute medication only to ensure it is switched back as soon as the stock issue is resolved

24th May 2019

Suitable for prescribing in primary care following recommendation from gastroenterology only (for bile acid malabsorption in patients with a true intolerance to colestyramine and colestipol). Gastroenterology will have to obtain ‘Prior Approval’ from the Medicines Optimisation team.

GPs will be notified by Medicines Optimisation team if approved for use in individual patients.

APCO September 2016.

For treating primary heterozygous-familial and non-familial hypercholesterolaemia as per NICE TA385.

Decision to start ezetimibe should be made in conjunction with specialist advice oxon.diabetes_lipidsadvice@nhs.net.

See Lipid Modification Guidance.

APCO July 2016.

Decision to start a fibrate should be made in conjunction with specialist advice oxon.diabetes_lipidsadvice@nhs.net.

See Lipid Modification Guidance.

Decision to start a fibrate should be made in conjunction with specialist advice oxon.diabetes_lipidsadvice@nhs.net.

See Lipid Modification Guidance.

For lipid modification, see Lipid Modification Guidance.

NB. Simvastatin 80 mg is not recommended - MHRA warning.

APCO September 2015.

Pravastatin, up to 40mg, is a third line alternative for primary prevention in patients who cannot take simvastatin or atorvastatin due to interactions.

See Lipid Modification Guidance.

APCO September 2015.

Rosuvastatin is a third line option for secondary prevention in patients who cannot take simvastatin or atorvastatin due to interactions.

See Lipid Modification Guidance.

APCO September 2015.

Secondary care use only for treating familial chylomicronaemia syndrome as per NICE HST13.

APCO November 2020.

Secondary care use only. Sclerotherapy of reticular veins and spider veins in legs and varicose veins.