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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.06  Expand sub section  Nitrates, calcium-channel blockers, and potassium-channel activators
02.06  Expand sub section  Angina
02.06.01  Expand sub section  Nitrates
Glyceryl Trinitrate Sublingual spray
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Formulary
Green
 
   
Glyceryl Trinitrate Sublingual tablets
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Formulary
Green
 
   
Glyceryl Trinitrate Transdermal patch
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Restricted Drug Restricted
Brown

Only for those who cannot have oral therapy.

 
   
Isosorbide Mononitrate
(Standard-release)
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Formulary
Green
 
Link  PrescQIPP: ISMN review
   
Isosorbide Mononitrate MR
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Formulary
Green

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

 
   
02.06.02  Expand sub section  Calcium-channel blockers
Amlodipine
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First Choice
Green

First line calcium-channel blocker for hypertension.

Could be considered for the treatment of co-morbid hypertension / angina in patients with heart failure, see The Management of Heart Failure in Primary Care.

 
Diltiazem Hydrochloride
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Formulary
Green
 
   
Lacidipine
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Formulary
Green
 
   
Lercanidipine
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Formulary
Green
 
   
Nifedipine
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Formulary
Green
 
   
Nimodipine (Nimotop®)
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Formulary
Red

Specialist prescribing only.

 
   
Verapamil Hydrochloride
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Formulary
Green
 
Link  UKMI Q&A: Evidence for verapamil for cluster headache
   
02.06.03  Expand sub section  Other anitanginal drugs to top
Nicorandil
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Formulary
Green
 
Link  MHRA drug safety update Nov 2015 risk of serious skin, mucosal, and eye ulceration, gastrointestinal ulcers which may progress to perforation, haemorrhage, fistula, or absces
   
Ivabradine (Procoralan®)
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Formulary

Amber Traffic Light 

  • 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). 

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


APCO March 2013.

 

 
Link  MHRA: Cardiac side effects of ivabradine - risk minimisation advice
Link  MHRA: Carefully monitor for bradycardia
Link  NICE CG126: Guidance on Stable Angina (2011)
   
Ranolazine (Ranexa®)
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Formulary
Amber Shared Care Protocol

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

APCO July 2012.

 
Link  NICE CG126: Guidance on Stable Angina (2011)
   
Perhexiline Maleate 100mg Tablets
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Unlicensed Drug Unlicensed
Red

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

APCO November 2013.

 
   
02.06.04  Expand sub section  Peripheral vasodilators and related drugs
Naftidrofuryl Oxalate
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Formulary
Amber Continuation

For the treatment of intermittent claudication as per NICE TA223.

APCO July 2011.

 
Link  NICE CG147: Lower limb peripheral arterial disease management
Link  NICE TA223: Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease
   
Pentoxifylline (Trental®)
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Formulary

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

APCO November 2012.

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

APCO November 2013.

Red Traffic Light  For gastric/liver indications.

APCO January 2014.

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

APCO July 2011.

 
Link  NICE TA223: Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease
   
02.06.04  Expand sub section  Other preparations used in peripheral vascular disease
 ....
 Non Formulary Items
Amlodipine and Valsartan  (Exforge®)

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Non Formulary
 
Cilostazol  (Pletal®)

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Non Formulary
Black

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

APCO July 2011.

Link  MHRA: Cilostazol (Pletal) - Risks of cardiovascular and bleeding events
Link  NICE TA223: Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease
 
Felodipine

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Non Formulary
 
Inositol Nicotinate  (Hexopal®)

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Non Formulary
Black

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

APCO July 2011.

Link  NICE TA223: Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease
 
Isosorbide Dinitrate
(Parenteral preparations)

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Non Formulary
 
Isosorbide Dinitrate tablets

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Non Formulary

Isosorbide dinitrate is a pro-drug of isosorbide mononitrate, consider prescribing isosorbide mononitrate.

 
Isradipine  (Prescal®)

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Non Formulary
 
Moxisylyte  (Opilon®)

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Non Formulary
 
Nicardipine

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Non Formulary
 
Nisoldipine  (Syscor® MR)

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Non Formulary
 
Oxerutins  (Paroven®)

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Non Formulary
 
  
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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