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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.12  Expand sub section  Lipid-regulating drugs
Alirocumab (Praluent®)
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Formulary
Red
High Cost Medicine

For primary hypercholesterolaemia and mixed lipidaemia as per NICE TA393.

APCO July 2016.

 
Link  NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
Evolocumab (Repatha® )
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Formulary
Red
High Cost Medicine

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

APCO July 2016.

 
Link  NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
02.12  Expand sub section  Bile acid sequestrants
Colestyramine
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Formulary
Amber Continuation

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

 
   
Colestipol (Colestid®)
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Formulary
Amber Continuation

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

 
   
Colesevelam (Cholestagel®)
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Formulary
Amber Continuation

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.

 
Link  NICE Evidence Summary: Colesevelam for bile acid malabsorption
   
02.12  Expand sub section  Ezetimibe
Ezetimibe (Ezetrol®)
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Formulary
Amber Continuation

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.

 
Link  NICE TA385: Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia
   
02.12  Expand sub section  Fibrates
Bezafibrate
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Formulary
Amber Continuation

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

See Lipid Modification Guidance.

 
   
Fenofibrate
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Formulary
Amber Continuation

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

See Lipid Modification Guidance.

 
   
02.12  Expand sub section  Statins to top
Atorvastatin
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First Choice
Green

Atorvastatin is the first line statin, usually at 20 mg for primary prevention and 40-80 mg for secondary prevention.

See Lipid Modification Guidance.

APCO September 2015.

 
Simvastatin
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Second Choice
Green

For lipid modification, see Lipid Modification Guidance.

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

APCO September 2015.

 
Link  MHRA: Interaction and dosing recommendations
Link  MHRA: Simvastatin - dose limitations with concomitant amlodipine or diltiazem
   
Pravastatin
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Third Choice
Green

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
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Third Choice
Green

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.

 
Link  Rosuvastatin PrescQIPP review
   
02.12  Expand sub section  Nicotinic acid group
02.12  Expand sub section  Omega-3 fatty acid compounds
02.12  Expand sub section  PCSK9 inhibitors
02.12  Expand sub section  Other lipid modifying agents
Volanesorsen (Waylivra®)
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Formulary
Red

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

APCO November 2020.

 
Link  NICE HST13: Volanesorsen for treating familial chylomicronaemia syndrome
   
 ....
 Non Formulary Items
Acipimox  (Olbetam®)

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Non Formulary

Not recommended in line with Lipid Modification Guidance.

 
Atorvastatin and Ezetimibe  (Atozet®)

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Non Formulary
 
Ciprofibrate

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Non Formulary
 
Fluvastatin

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Non Formulary
 
Gemifibrozil

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Non Formulary
 
Lomitapide  (Lojuxta®▼)

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Non Formulary
Black
High Cost Medicine

Not routinely commissioned by NHS England for homozygous familial hypercholesterolaemia.

APCO May 2014.

 
Nicotinic Acid  (Solgar Niacin®)

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Non Formulary

Not recommended in line with Lipid Modification Guidance.

 
Omega-3-Acid Ethyl Esters  (Omacor®)

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Non Formulary
Black

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

See Lipid Modification Guidance.

NB. Omacor contains soya oil. If you are allergic to peanut or soya, do not use this medicinal product.

APCO March 2018.

Link  NICE therapeutic topic: Omega-3 fatty acid supplements
Link  NICE: schizophrenia - omega-3 fatty acid medicines
Link  PrescQIPP: Omega 3 fatty acids review
 
Simvastatin and Ezetimibe  (Inegy®)

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Non Formulary
 
Simvastatin and Fenofibrate  (Cholib®)

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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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