| Formulary Chapter 2: Cardiovascular system - Full Chapter
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| Chapter Links... |
 Academic Health Science Network (North East and North Cumbria) - Atrial Fibrilation |
| County Durham and Darlington DVT Pathway Information |
| County Durham and Tees Valley Prescribing Guideline for the Use of Anticoagulants in Non-Valvular Atrial Fibrillation |
| NICE NG148: Acute kidney injury: prevention, detection and management |
| NICE NG191: COVID-19 rapid guideline: managing COVID-19 |
| North Cumbria - Cardiovascular workplan 2022 |
| South Tees Hospitals Cardiology drug prescribing guidelines & formulary |
| Details... |
| 02.03 |
Anti-arrhythmic drugs |
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Magnesium Sulphate Injection
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Formulary
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MHRA Drug Safety Update (May 2019): Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy
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| 02.03.01 |
Management of arrhythmias |
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| 02.03.02 |
Drugs for arrhythmias |
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| 02.03.02 |
Supraventricular arrhythmias |
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Adenosine
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Formulary
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- 6mg in 2ml injection
- 25mg in 5ml injection
 unlicensed
- 30mg in 10ml injection for infusion - NHCT only
- 130mg in 130ml IV infusion unlicensed
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Regadenoson
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Formulary
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- For radionuclide myocardial perfusion imaging in patients who are unable to undergo adequate exercise stress (e.g. COPD and asthma patients where dobutamine is indicated, and obese patients who require several vials of adenosine).
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| 02.03.02 |
Supraventricular and ventricular arrhythmias |
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Amiodarone
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Formulary
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- 100mg & 200mg tablets
- 50mg in 5ml suspension is also approved unlicensed
- 150mg/3ml & 300mg/10ml injection
NHS England (June 2019) advises that prescribers should not initiate amiodarone in primary care for any new patient.
in exceptional circumstances, where there is a clinical need for amiodarone to be prescribed, this should be undertaken in a cooperation arrangement with a multi-disciplinary team and/or other healthcare professional. Amiodarone has an important place in the treatment of severe cardiac rhythm disorders where other treatments either cannot be used or have failed. It has potential major toxicity and its use requires monitoring both clinically and via laboratory testing.
MHRA Drug Safety Update (Mar 2022): Amiodarone (Cordarone X): reminder of risks of treatment and need for patient monitoring and supervision
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 NENC Shared Care Protocol - Amiodarone for patients in adult services
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Atenolol
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Formulary
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Flecainide
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Formulary
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- 50mg & 100mg tablets
- 5mg in 1ml liquid unlicensed.
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Propafenone
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Formulary
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Disopyramide
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Formulary
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Dronedarone
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Formulary
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- Approved for patients who are unsuitable for or not tolerant of amiodarone. Treatment should be initiated by a cardiologist.
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NENC Shared Care Protocol - dronedarone for patients in adult services
NICE TA197 (Atrial fibrillation - dronedarone)
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Flecainide Injection
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Formulary
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Mexiletine
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Formulary
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- unlicensed
- ECG monitoring is required to be carried out by as part of the initiation process of mexiletine.
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Sotalol
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Formulary
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Ajmaline
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Unlicensed
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- For use as a diagnostic test of Brugada syndrome.
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| 02.03.02 |
Ventricular arrhythmias |
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Lidocaine
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Formulary
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- 100mg injection, pre-filled syringes
- 1mg/ml (0.1%) & 2mg/ml (0.2%) IV infusions 500ml
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment.
In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.
For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing. |
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Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement.
The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber.
If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care. |
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Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs. |
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Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care. |
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NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria. |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status. |
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