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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.01  Positive inotropic drugs
02.01.01  Cardiac glycosides
Digoxin
(Import from USA)
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Formulary

Unlicensed formulation: paediatric injection (100 microgram in 1ml)

 
   
02.01.01  Digoxin-specific antibody
Digoxin specific antibody fragments (Digifab®)
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Formulary Ordered when needed. Seek specialist advice 
   
02.01.02  Phosphodiesterase type-3 inhibitors
Milrinone (Primacor®)
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Formulary  
   
02.02  Diuretics to top
02.02.01  Thiazides and related diuretics
Chlorothiazide
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Formulary Unlicensed formulation: suspension 
   
Metolazone
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Restricted Drug Restricted Not routinely stocked.
Available to order on consultant request for a named patient 
   
02.02.02  Loop diuretics
Furosemide
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Formulary  
   
02.02.03  Potassium-sparing diuretics and aldosterone antagonists
Amiloride Hydrochloride
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Formulary  
   
02.02.03  Aldosterone antagonists
Spironolactone
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Formulary Unlicensed formulation: suspension 
   
Potassium Canrenoate
(Injection)
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Formulary unlicensedunlicensed 
   
02.02.04  Potassium-sparing diuretics with other diuretics to top
02.02.05  Osmotic diuretics
Mannitol
(IV infusion)
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Formulary  
   
02.02.07  Carbonic anhydrase inhibitors
02.03  Anti-arrhythmic drugs
02.03.01  Management of arrhythmias
02.03.02  Drugs for arrhythmias to top
02.03.02  Supraventricular arrhythmias
Adenosine (Adenocor®)
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Formulary  
   
02.03.02  Supraventricular and ventricular arrhythmias
Amiodarone
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Formulary
Amber
 
   
Flecainide
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Formulary Unlicensed formulation: suspension (not routinely stocked) 
   
02.03.02  Ventricular arrhythmias
Lidocaine
(Cardiac)
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Formulary  
   
02.04  Beta-adrenoceptor blocking drugs
Atenolol
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Formulary  
   
Propranolol
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Formulary  
   
Labetalol
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Formulary  
   
Esmolol
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Restricted Drug Restricted  
Link  Link to SPC (not available on emc)
   
02.05  Hypertension and Heart Failure to top
02.05.01  Vasodilator antihypertensive drugs
Diazoxide (Eudemine®)
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Formulary Unlicensed formulation: suspension 
   
Epoprostenol (Flolan®)
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Formulary  
   
Hydralazine
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Formulary  
   
Sildenafil (Revatio®)
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Formulary
High Cost Medicine
 
   
Sodium Nitroprusside
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Formulary Unlicensed
 
   
Nitric Oxide
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Formulary  
   
02.05.02  Centrally acting antihypertensive drugs
Clonidine Hydrochloride
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Formulary Unlicensed formulation: suspension 
   
02.05.03  Adrenergic neurone blocking drugs
Guanethidine Monosulphate (Ismelin®)
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Formulary For use by Pain team 
   
02.05.04  Alpha-adrenoceptor blocking drugs
Doxazosin
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Formulary  
   
Prazosin
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Formulary  
   
02.05.04  Phaeochromocytoma to top
Phenoxybenzamine Hydrochloride
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Formulary  
   
Phentolamine Mesilate (Rogitine®)
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Formulary  
   
02.05.05  Drugs affecting the renin-angiotensin system
02.05.05.01  Angiotensin-converting enzyme inhibitors (ACE inhibitors)
Captopril
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Formulary Suspension: unlicensed product 
   
Enalapril
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Formulary  
   
Lisinopril
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Formulary  
   
02.05.05.02  Angiotensin-II receptor antagonists
Losartan
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Formulary  
   
02.06  Nitrates, calcium-channel blockers, and other anti-anginal drugs
02.06.01  Nitrates to top
Glyceryl Trinitrate
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Formulary  
   
02.06.02  Calcium-channel blockers
Amlodipine
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Formulary  
   
Nifedipine
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Formulary Unlicensed formulation: oral solution 
   
Nifedipine (Adalat® LA)
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Formulary Brand should be specified when prescribing as different MR preparations may not have same clinical effect. 
   
Nifedipine (Adalat® Retard)
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Formulary Brand should be specified when prescribing as different MR preparations may not have same clinical effect. 
   
Nimodipine
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Restricted Drug Restricted Available to order for a named patient on consultant request  
   
02.06.04  Peripheral vasodilators and related drugs
02.07  Sympathomimetics
02.07.01  Inotropic sympathomimetics
Dobutamine
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Formulary  
   
Dopamine
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Formulary  
   
Isoprenaline
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Formulary Some formulations: unlicensed 
   
Argipressin (Synthetic Vasopressin) (Pitressin®)
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Formulary  
   
02.07.02  Vasoconstrictor sympathomimetics to top
Ephedrine
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Formulary  
   
Metaraminol
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Formulary Unlicensed formulation 
   
Noradrenaline / Norepinephrine
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Formulary  
   
Phenylephrine
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Formulary  
   
02.07.03  Cardiopulmonary resuscitation
Adrenaline / Epinephrine
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Formulary  
   
02.08  Anticoagulants and protamine
02.08.01  Parenteral anticoagulants
02.08.01  Heparin
Heparin
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Formulary  
   
02.08.01  Low molecular weight heparins to top
Dalteparin (Fragmin®)
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Formulary Restricted use for patients transferred to SCH established on treatment 
   
Enoxaparin (Clexane®)
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Formulary
Red
 
   
Tinzaparin (Innohep®)
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Formulary Restricted use for patients transferred to SCH establised on treatment 
   
02.08.01  Heparinoids
02.08.01  Hirudins
02.08.01  Heparin flushes
Heparin
(Flush)
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Formulary  
   
02.08.01  Epoprostenol
Epoprostenol (Flolan®)
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Formulary  
   
02.08.01  Fondaparinux to top
02.08.02  Oral anticoagulants
Warfarin
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Formulary  
   
Rivaroxaban (Xarelto®)
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Restricted Drug Restricted
Amber
Only according to Guidelines for Assessing Venous Thromboembolism Risk Amongst Inpatients Aged 18 or Over


Sheffield Traffic Lights: see for more details as in red/amber/green lists dependant on indication. 
Link  NICE TA256: Rivaroxaban for the prevention of stroke and systemic embolism in patients with AF
Link  NICE TA261: Rivaroxaban for treatment of DVT
   
02.08.02  Atrial Fibrillation
02.08.02  VTE Prophylaxis
02.08.03  Protamine sulphate
Protamine Sulphate
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Formulary  
   
02.09  Antiplatelet drugs to top
Aspirin (antiplatelet)
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First Choice  
Clopidogrel
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Second Choice  
   
02.10  Stable angina, acute coronary syndromes, and fibrinolysis
02.10.02  Fibrinolytic drugs
Alteplase (Actilyse®)
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Formulary  
Link  NICE TA264: Ischaemic stroke (acute) - alteplase
   
Urokinase
(Injection 10000 units)
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Formulary Unlicensed 
   
Streptokinase
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Restricted Drug Restricted For Genetics Only 
   
02.11  Antifibrinolytic drugs and haemostatics
Tranexamic Acid
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Formulary Mouthwash (can be used orally): unlicensed formulation 
   
02.11  Blood-related products
02.12  Lipid-regulating drugs to top
02.12  Statins
Simvastatin
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First Choice  
Atorvastatin
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Restricted Drug Restricted Metabolic team use only.
Not routinely stocked - can be ordered on request. 
Link  MHRA advice on atorvastatin interactions and doses (NB information on simvastatin contained in this has been superseded- see simvastatin)
Link  NPC: Info on simvstatin 80mg vs atorvastatin 80mg (Aug 2010)
   
02.12  Bile acid sequestrants
Colestyramine
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Formulary  
   
02.12  Ezetimibe
02.12  Fibrates
Fenofibrate
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Formulary  
   
02.12  Nicotinic acid group to top
02.12  Omega-3 fatty acid compounds
02.12  PCSK9 inhibitors
02.12  Other lipid modifying agents
02.13  Local sclerosants
Ethanolamine Oleate
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Formulary  
   
02.14  Drugs affecting the ductus arteriosus to top
Alprostadil (Prostin VR®)
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Formulary  
   
 ....
 Non Formulary Items
Abciximab

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Non Formulary
 
Acebutolol  (Sectral®)

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Non Formulary
 
Acenocoumarol  (Sinthrome®)

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Non Formulary
 
Acipimox  (Olbetam®)

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Non Formulary
 
Ambrisentan

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Non Formulary
Red
Link  National Pulmonary Hypertension commissioning policy
 
Apixaban

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Non Formulary
Red
 
Aprotinin  (Trasylol®)

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Non Formulary
Link  MHRA withdrawal information
 
Argatroban  (Exembol®)

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Non Formulary
 
Atenolol and Co-amilozide  (Kalten®)

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Non Formulary
 
Atenolol and Nifedipine  (Beta-Adalat®)

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Non Formulary
 
Atenolol and Nifedipine  (Tenif®)

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Non Formulary
 
Azilsartan
(Edarbi)

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Non Formulary
 
Bendroflumethiazide

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Non Formulary
 
Bezafibrate

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Non Formulary
 
Bisoprolol

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Non Formulary
 
Bivalirudin  (Angiox®)

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Non Formulary
Link  MHRA Drug Safety Update: Risks associated with non approved bivalirudin regimes
Link  NICE TA230: Bivalirudin for the treatment of STEMI, 2011
 
Bosentan  (Tracleer®)

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Non Formulary
Red
Link   National Pulmonary Hypertension commissioning policy
 
Bumetanide

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Non Formulary
 
Burinex A®

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Non Formulary
 
Candesartan

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Non Formulary
 
Captopril Tablets 2 mg

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Non Formulary unlicensedunlicensed
 
Carvedilol

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Non Formulary
 
Celiprolol Hydrochloride

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Non Formulary
 
Chlortalidone

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Non Formulary
 
Cilazapril  (Vascace®)

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Non Formulary
 
Cilostazol  (Pletal®)

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Non Formulary
 
Ciprofibrate  (Modalim®)

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Non Formulary
 
Co-amilofruse (furosemide and amiloride)

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Non Formulary
 
Co-amilozide

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Non Formulary
 
Co-flumactone

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Non Formulary
 
Colesevelam  (Cholestagel®)

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Non Formulary
 
Colestipol Hydrochoride  (Colestid®)

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Non Formulary
 
Co-tenidone (atenolol and chlortalidone)

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Non Formulary
 
Co-triamterzide

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Non Formulary
 
Cozaar- Comp®
(Losartan & hydrochlorothiazide)

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Non Formulary
 
Cyclopenthiazide  (Navidrex®)

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Non Formulary
 
Dabigatran etexilate  (Pradaxa®)

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Non Formulary
Link  MHRA clarification on contraindications, 2012
Link  MHRA communication on renal function assessment, 2011
Link  NICE TA249: Dabigatran for Stroke prevention in AF
 
Danaparoid Sodium  (Orgaran®)

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Non Formulary
 
Digitoxin

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Non Formulary
Link  ukmi
 
Diltiazem

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Non Formulary
 
Dipyridamole

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Non Formulary
 
Disopyramide

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Non Formulary
 
Dopexamine

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Non Formulary
 
Dronedarone  (Multaq®)

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Non Formulary
Red
Link  MHRA advice on risk of cardiac failure and hepatotoxicity
Link  MHRA Oct 2011: Cardiovascular, hepatic and pulmonary adverse effects - restrictions and monitoring requirements
Link  NICE TA197: Atrial fibrillation - dronedarone
 
Dyazide®

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Non Formulary
 
Enoximone  (Perfan®)

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Non Formulary
 
Eplerenone

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Non Formulary
Amber
Link  NICE CG108: Chronic heart failure
 
Eptifibatide  (Integrilin®)

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Non Formulary
 
Etamsylate  (Dicynene®)

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Non Formulary
 
Ezetimibe  (Ezetrol®)

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Non Formulary
Link  NICE TA132: Hypercholesterolaemia - ezetimibe
 
Felodipine

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Non Formulary
 
Fluvastatin  (Lescol®)

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Non Formulary
 
Fondaparinux Sodium  (Arixtra®)

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Non Formulary
 
Fosinopril Sodium

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Non Formulary
 
Frusene®

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Non Formulary
 
Gemifibrozil

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Non Formulary
 
Hydrochlorothiazide

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Non Formulary unlicensedunlicensed
 
Iloprost injection

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Non Formulary
 
Iloprost nebules  (Vantavis®)

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Non Formulary
 
Imidapril Hydrochloride  (Tanatril®)

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Non Formulary
 
Indapamide

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Non Formulary
 
Indoramin

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Non Formulary
 
Inositol Nicotinate  (Hexopal®)

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Non Formulary
 
Irbesartan  (Aprovel ®)

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Non Formulary
 
Isosorbide Dinitrate

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Non Formulary
 
Isosorbide Mononitrate

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Non Formulary
 
Isradipine  (Prescal®)

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Non Formulary
 
Kalspare®

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Non Formulary
 
Lacidipine  (Motens®)

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Non Formulary
 
Lasilactone®

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Non Formulary
 
Lepirudin  (Refludan®)

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Non Formulary
 
Lercanidipine Hydrochloride  (Zanidip®)

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Non Formulary
 
Methyldopa

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Non Formulary
 
Metoprolol

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Non Formulary
 
Mexiletine

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Non Formulary
Red
 
Minoxidil

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Non Formulary
 
Moexipril Hydrochloride  (Perdix®)

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Non Formulary
 
Moracizine

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Non Formulary
 
Moxisylyte  (Opilon®)

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Non Formulary
 
Moxonidine

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Non Formulary
 
Nadolol  (Corgard®)

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Non Formulary
 
Naftidrofuryl Oxalate

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Non Formulary
Link  Bandolier review of drug treatment of peripheral arterial disease
 
Navispare®

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Non Formulary
 
Nebivolol  (Nebilet®)

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Non Formulary
 
Nicardipine Hydrochloride  (Nicardipine®)

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Non Formulary
 
Nicotinic Acid  (Niaspan®)

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Non Formulary
 
Nicotinic acid/ laropiprant  (Tredaptive ®)

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Non Formulary
 
Nimodipine  (Nimotop®)

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Non Formulary Available to order on advice of neurosurgeons
 
Nisoldipine  (Syscor® MR)

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Non Formulary
 
Olmesartan  (Sevikar®)

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Non Formulary
 
Omega-3-Acid Ethyl Esters  (Omacor®)

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Non Formulary
Link  UKMI QA: Review of evidence for dyslexia
 
Omega-3-Marine Triglycerides  (Maxepa®)

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Non Formulary
 
Oxprenolol Hydrochloride

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Non Formulary
 
Pentoxifylline  (Trental®)

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Non Formulary
 
Perindopril

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Non Formulary
 
Phenindione

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Non Formulary
 
Pindolol

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Non Formulary
 
Prasugrel  (Efient®)

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Non Formulary
Link  MHRA safety information on hypersensitivity May 2011
Link  NICE TA182: Acute coronary syndrome - prasugrel
 
Pravastatin

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Non Formulary
 
Procainamide

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Non Formulary unlicensedunlicensed
 
Propafenone

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Non Formulary
 
Quinapril

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Non Formulary
 
Ramipril

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Non Formulary
 
Reteplase  (Rapilysin®)

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Non Formulary
 
Rosuvastatin

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Non Formulary
 
Sevikar HCT®

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Non Formulary
 
Simvastatin and Ezetimibe  (Inegy®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sitaxentan Sodium  (Thelin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sodium Tetradecyl Sulphate  (Fibro-Vein®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sotalol

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tadalafil  (Adcirca®)
(Pulmonary hypertension)

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  National Pulmonary Hypertension commissioning policy
 
Tenecteplase  (Metalyse®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Terazosin

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ticagrelor  (Brilique®)

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Non Formulary
Link  NICE TAG 236
 
Timolol

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tirofiban  (Aggrastat®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tolazoline

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Torasemide

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Trandolapril  (Gopten®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Triamterene  (Dytac®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Valsartan

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Verapamil Hydrochloride

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Link  Evidence for verapamil for cluster headache UKMI Q+A
 
Xipamide  (Diurexan®)

View adult BNF View SPC online View childrens BNF Track Changes
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

Amber

Definition
Certain drugs that are initiated by a specialist but are suitable for GPs to continue ongoing prescribing. The specialist should provide the GP with necessary information and support in order for treatment to be managed safely in primary care. Shared care protocols (SCP) or prescribing guidelines may be available.
1. Requiring specialist assessment to enable patient selection.
2. Requiring a period of monitoring by a specialist.
3. The initial prescription should normally be issued by the specialist unless the agreed SCP states otherwise.
  

Black

Definition
A drug which should not be initiated in Sheffield unless exceptional circumstances apply to the individual concerned and an Individual Funding Request (IFR) has been agreed by NHS Sheffield CCG. The drug should not be withdrawn from patients already established on treatment but other treatment options should be considered at routine review.
Criteria
1. There is a clear NHS England Specialised Commissioning Group decision to not routinely fund usage of the drug.
2. There is a NICE recommendation that the drug should not be prescribed on the NHS for the condition specified.
3. A drug requiring specific commissioning arrangements to be clarified and put in place before prescribing can take place.
4. A drug in which the APG view of evidence of benefit over existing therapy does not justify routine availability.
  

Green

Drugs for which GPs should take full responsibility for initiating and ongoing prescribing
  

Red

Definition
Prescribing and ongoing supply is normally undertaken by a consultant or other physician within a secondary care service. In some exceptional circumstances and following discussion between primary and secondary care, GPs may consider it to be in the patient’s best interest for drugs in the Red section of the traffic light scheme to be prescribed in primary care.

Red traffic light drugs meet one or more of the following criteria:
1. Require specialist assessment to enable patient selection, initiation, ongoing treatment and monitoring of efficacy, toxicity or adverse effects.
2. Specifically designated as “hospital only “either by product licence or by DH
3. Hospital initiated clinical trial materials used in accordance with the trial protocol
4. Not listed in the current BNF or BNF (C).
5. Being used to treat a condition that is not suitable for primary care prescribing because of disease specific requirements, complexity or defined commissioning arrangements.
  

netFormulary