| 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... |
| 02.06 |
Nitrates, calcium-channel blockers, and potassium-channel activators |
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| 02.06 |
Angina |
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| 02.06.01 |
Nitrates |
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Glyceryl Trinitrate
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Formulary
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- 400 microgram/metered dose spray .
5mg & 10mg/day patches - for use in cardiothoracic critical care unit. .
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Glyceryl Trinitrate Injection
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Formulary
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- 5mg in 5ml , 50mg in 10ml & 50mg in 50ml injections
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Isosorbide Dinitrate 10mg in 10ml injection
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Formulary
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Isosorbide Mononitrate 10mg, 20mg and 40mg tablets, and 60mg MR tablets
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Formulary
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- 10mg, 20mg and 40mg tablets
- 60mg MR tablets - should only be used in patients when the non-modified release tablets are unsuitable
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| 02.06.02 |
Calcium-channel blockers |
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Amlodipine
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First Choice
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- Preferred calcium channel blocker for treating hypertension.
- If a 10mg dose is not tolerated e.g. due to leg/ankle
oedema, consider reducing dose before changing to an
alternative such as lercanidipine.
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MHRA Drug Safety Update (Dec 2014): Simvastatin: dose limitations with concomitant amlodipine or diltiazem
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Diltiazem
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First Choice
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- Preferred calcium channel blocker for angina.
- Zemtard® is the formulary brand of choice for starting new patients on long acting diltiazem.
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MHRA Drug Safety Update (Dec 2014): Simvastatin: dose limitations with concomitant amlodipine or diltiazem
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Felodipine
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Formulary
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- M/R tablets: 2.5mg, 5mg, 10mg
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Nimodipine Injection
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Formulary
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- 10mg in 50ml for IV infusion
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Verapamil Injection
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Formulary
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- Injection: 5mg/2ml (2.5mg/1ml)
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Lercanidipine
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Alternatives
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- For use as a second line calcium channel blocker where amlodipine is not tolerated.
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Nifedipine
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Alternatives
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- Once daily formualtions are preferred
- 20mg controlled release tablets (Adalat LA), 30mg & 60mg m/r capsules (Coracten XL)
- 5mg & 10mg capsules
- 10mg & 20mg retard tablets
- 20mg in 1ml (1mg/drop) nifedipine oral solution is also approved for use
 unlicensed.
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Verapamil
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Alternatives
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- Tablets - 40mg, 80mg, 120mg, 160mg
- MR Tablets - 240mg
- Oral Solution - 40mg/5ml
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Nimodipine
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Alternatives
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- 30mg tablets - treatment should be on the advice of the stroke team or a cardiologist.
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Nicardipine 1mg in 1ml injection
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Alternatives
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- Approved as a second line agent for the treatment of aortic dissection and pre-eclampsia.
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| 02.06.03 |
Other anitanginal drugs |
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Nicorandil
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Formulary
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MHRA Drug Safety Update (Jan 2016): Nicorandil (Ikorel): now second-line treatment for angina - risk of ulcer complications
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Ivabradine
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Formulary
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- Angina - for intiation on advice from a consultant cariologist in patients with contra-indications to or intolerance of beta-blockers.
- Heart failure - approved for use in accordance with NICE guidelines.
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NICE CG126: Guidance on Stable Angina (2011)
MHRA Drug Safety Update (Dec 2014): Ivabradine (Procoralan) in the symptomatic treatment of angina: risk of cardiac side effects
NICE TA267: Ivabradine for treating chronic heart failure
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Ranolazine
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Formulary
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- For use in the treatment of angina in those patients for whom other treatments have been unsuccesful.
- Initial prescribing should be by a consultant cardiologist only.
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NICE CG126: Guidance on Stable Angina (2011)
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| 02.06.04 |
Peripheral vasodilators and related drugs |
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Naftidrofuryl
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Formulary
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- Approved for the treatment of intermittent claudication in people with peripheral arterial disease.
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NICE CG147: Lower limb peripheral arterial disease management
NICE TA223: Intermittent claudication drugs
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| 02.06.04 |
Other preparations used in peripheral vascular disease |
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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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Description |
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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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