netFormulary Oxfordshire Clinical Commissioning Group NHS
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.05  Expand sub section  Drugs affecting the renin-angiotensin system and some other antihypertensive drugs
02.05.01  Expand sub section  Vasodilator antihypertensive drugs
Hydralazine
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Formulary
Green

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

 
   
Iloprost injection
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Formulary
Red
High Cost Medicine

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

 
Link  Commissioning Policy - Pulmonary hypertension in adults
Link  NICE: Review of evidence
   
Macitentan (Opsumit®)
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Formulary
Red
High Cost Medicine
NHS England

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.

 
Link  National Pulmonary Hypertension commissioning policy
   
Minoxidil (Loniten®)
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Formulary

Amber Traffic Light  For continuation in primary care following specialist initiation for hypertension.

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

 
   
Sildenafil (Revatio®)
(Pulmonary hypertension)
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Formulary
Red
High Cost Medicine

Secondary care use only. 

APCO March 2011.

 
Link  National Pulmonary Hypertension commissioning policy
Link  NICE Evidence summary: Pulmonary hypertension in neonates - Sildenafil
   
Sodium nitroprusside
Unlicensed Drug Unlicensed
Red

Secondary care use only. 

 
   
02.05.02  Expand sub section  Centrally acting antihypertensive drugs
Clonidine (Catapres®)
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Formulary
Green
 
   
Methyldopa
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Formulary
Green
 
   
02.05.03  Expand sub section  Adrenergic neurone blocking drugs
02.05.04  Expand sub section  Alpha-adrenoceptor blocking drugs to top
Doxazosin
(Standard-release)
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First Choice
Green
 
Prazosin
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Formulary
Green
 
   
02.05.04  Expand sub section  Phaeochromocytoma
Phenoxybenzamine Hydrochloride
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Amber Continuation

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

 
   
Phentolamine (Rogitine®, Regitin®)
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Formulary
Red

Specialist prescribing only.

 
   
02.05.05  Expand sub section  Drugs affecting the renin-angiotensin system
02.05.05.01  Expand sub section  Angiotensin-converting enzyme inhibitors (ACE inhibitors)
Ramipril
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First Choice
Green

First choice ACE inhibitor in management of heart failure. See The Management of Heart Failure in Primary Care.

 
Lisinopril
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Second Choice
Green

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

 
   
Perindopril Erbumine or Tert-butylamine
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Formulary
Green
 
   
Captopril
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Restricted Drug Restricted
Brown

Restricted for paediatric use.

 
   
Enalapril Maleate
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Restricted Drug Restricted
Brown

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

APCO November 2005.

 
   
02.05.05.02  Expand sub section  Angiotensin-II receptor antagonists
Candesartan
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First Choice
Green

Candesartan is the preferred Angiotensin II receptor antagonist for patients intolerant of ACE inhibitors due to cough.

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

 
Losartan
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Second Choice
Green

For patients intolerant of ACE inhibitors due to cough.

 
   
Irbesartan
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Formulary
Green

For patients intolerant of ACE inhibitors due to cough.

 
   
Sacubitril valsartan▼ (Entresto®)
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Formulary
Amber Shared Care Protocol

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.

 
Link  NICE TA388: Sacubitril valsartan for heart failure
Link  SMC advice (March 2016)
   
02.05.05.03  Expand sub section  Renin inhibitors to top
 ....
 Non Formulary Items
Aliskiren  (Rasilez®)

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Non Formulary
Black

Not recommended for use due to lack of comparative clinical and cost effectiveness data and local guidance.

Link  MHRA: Aliskiren (Rasilez▼): risk of cardiovascular and renal adverse reactions—new contraindications and warnings
 
Ambrisentan

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Non Formulary
Black
High Cost Medicine

This drug is commissioned by NHS England for pulmonary arterial hypertension as per policy: NHSE A11/P/b.

The OUHFT is not a designated centre.

Link  National Pulmonary Hypertension commissioning policy
 
Azilsartan  (Edarbi®)

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Non Formulary
Black

No evidence to support place in therapy over other cost-effective alternatives.

APCO September 2012.

 
Bosentan  (Tracleer®)

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Non Formulary
Black
High Cost Medicine

This drug is commissioned by NHS England for digital ulcers and pulmonary arterial hypertension as per policy:


The OUHFT is not a designated centre.

 
Captopril and Hydrochlorothiazide  (Capozide®)

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Non Formulary
 
Captopril and Hydrochlorothiazide  (Co-zidocapt®)

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Non Formulary
 
Cilazapril  (Vascace®)

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Non Formulary

Discontinued in 2014.

 
Cozaar- Comp®
(Losartan & hydrochlorothiazide)

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Non Formulary
 
Doxazosin MR

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Non Formulary
Black

Modified release preparation is Non-Formulary. Please use the standard-release preparation.

NB: there is no need for a modified-release preparation as standard-release doxazosin is once daily.

APCO September 2009.

 
Enalapril and Hydrochlorothiazide  (Innozide®)

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Non Formulary
 
Eprosartan  (Teveten®)

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Non Formulary
 
Fosinopril Sodium  (Staril®)

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Non Formulary
 
Guanethidine Monosulphate  (Ismelin®)

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Non Formulary
 
Iloprost nebules  (Vantavis®)

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Non Formulary

For pulmonary arterial hypertension.

Funded by specialised commissioning.

 
Imidapril  (Tanatril®)

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Non Formulary
 
Indoramin

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Non Formulary
 
Lisinopril and Hydrochlorothiazide  (Carace® Plus)

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Non Formulary
 
Lisinopril and Hydrochlorothiazide  (Lisicostad®)

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Non Formulary
 
Lisinopril and Hydrochlorothiazide  (Zestoretic®)

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Non Formulary
 
Moexipril  (Perdix®)

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Non Formulary
 
Moxonidine

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Non Formulary
 
Olmesartan  (Sevikar®)

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Non Formulary
 
Perindopril Arginine  (Coversyl® Arginine )

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Non Formulary
Black

Use equivalent dose of perindopril erbumine (also known as tert-butylamine).

Where:
5mg perindopril arginine ≡ 4mg perindopril erbumine

Recommendation from NHSE as part of Items which should not routinely be prescribed in primary care: Guidance for CCGs.

APCO January 2018.

 
Perindopril Arginine and Indapamide  (Coversyl® Arginine Plus)

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Non Formulary
Black

Use equivalent dose of perindopril erbumine (also known as tert-butylamine).

Where:
5mg perindopril arginine ≡ 4mg perindopril erbumine

In line with Medicines Management and Therapeutics Committee decision.

APCO July 2009.

 
Quinapril  (Accupro®)

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Non Formulary
 
Quinapril and Hydrochlorothiazide

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Non Formulary
 
Ramipril and Felodipine  (Triapin®)

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Non Formulary
 
Riociguat  (Adempas®)

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Non Formulary
High Cost Medicine
 
Sevikar HCT®

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Non Formulary
 
Sildenafil
(Digital ulcers)

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Non Formulary

This drug is commissioned by NHS England for digital ulcers as per policy NHSE A13/P/b. The OUHFT is not a designated centre.

Link  NHSE Clinical Commissioning Policy: Treatment of Digital Ulceration in Systemic Sclerosis
Link  NICE Evidence summary: Sildenafil for digital ulcers
 
Sitaxentan Sodium  (Thelin®)

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Non Formulary

Sitaxentan has been withdrawn from the market because the benefit of treatment does not outweigh the risk of severe hepatotoxicity.

 
Tadalafil  (Adcirca®)
(Pulmonary hypertension)

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Non Formulary
 
Telmisartan

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Non Formulary
 
Terazosin

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Non Formulary
 
Tolazoline

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Non Formulary
 
Trandolapril  (Gopten®)

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Non Formulary
 
Trandolapril and Verapamil  (Tarka®)

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Non Formulary
 
Valsartan

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Non Formulary

Several suppliers are experiencing intermittent supply issues with valsartan products.

 
  
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
SMC
Scottish Medicines Consortium
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

Red

Red: Medicines which should only be prescribed in secondary care by a specialist.  

Amber Continuation

Amber Continuation: Medicines which should be initiated or recommended by a specialist for continuation in primary care. The specialist must notify the GP that the prescribing responsibility has been transferred.   

Amber Shared Care Protocol

Amber Shared Care Protocol: Medicines which are appropriate to be initiated and stabilised by a specialist, once stabilised the medicine may be appropriate for responsibility to be transferred from secondary to primary care with the agreement of a GP and a formal ‘shared care’ agreement. The shared care protocol must be approved by the Area Prescribing Committee Oxfordshire (APCO).   

Green

Green: Medicines which are suitable for initiation and ongoing prescribing within primary care.   

Brown

Brown: Medicines which should only be prescribed in restricted circumstances.  

Black

Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.  

OCCG Green

not used  

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