BNF Chapter 2

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Cardiovascular System

 

1 ARRYTHMIAS
Class 1A AntiarrhythmicsNOTES
DISOPYRAMIDECapsules 100mgAPC traffic light status: BLUE
Class 1B AntiarrhythmicsNOTES
LIDOCAINEMinijet 2%APC traffic light status: GREEN
LIDOCAINE0.2% in GLUCOSE 5% 500ml InfusionAPC traffic light status: RED
Class 1C AntiarrhythmicsNOTES
FLECAINIDETablets 50mg

Liquid 25mg in 5ml (unlicensed)

NICE Guidelines AF [CG180]
SIGN Guidelines ArrhythmiasAPC traffic light status: BLUE
Injection 150mg in 15ml (unlicensed)Restricted to use by or under advise of cardiology consultants only.

Licensed IV flecainide has been discontinued. Unlicensed product on formulary for:

– Atrial fibrillation/flutter associated with Wolf-Parkinson White syndrome and cardioversion

-Acute atrial fibrillation where IV cardioversion in required and amiodarone is contraindicated.

PROPAFENONETablets 150mgAPC traffic light status: BLUE
Class 3 AntiarrhythmicsNOTES
AMIODARONETablets 100mg, 200mgRefer to Shared Care Guidance

Minimum of 3 months prescribing required before transfer of prescribing to GP can be requested.

NICE Guidelines AF [CG180]
SIGN Guidelines Arrhythmias

APC traffic light status: AMBER

Injection 150mg in 3ml, 300mg in 10ml (in Crash boxes)APC traffic light status: RED
DRONEDARONETablets 400mgRESTRICTED to Cardiology Consultants Only
NICE Guidelines Non-Permanent AF [TA197]APC Policy Statement: Dronedarone (Aug 2019)APC traffic light status: RED
Other AntiarrhythmicsNOTES
ADENOSINEInjection 6mg in 2ml

Injection (ADENOSCAN) 30MG in 10ml

Contra-indicated in asthmatics; verapamil may be alternative

ADENOSCAN RESTRICTED Diagnostic Use Only Imaging/X-Ray

(radionuclide myocardial perfusion imaging)

APC traffic light status: RED

MEXILETINEcapsules, 167mg (equivalanet to 200mg mexiletine hydrochloride)Prescribing should be by a specialist only, in line with NICE and/or local pathways. Commissioned by NHSE.

APC Policy Statement: Mexilitene for ventricular arrythmia (Aug 2019)

APC traffic light status: RED

PROCAINAMIDE Injection 1g in 10mlUnlicensed product
Beta-Adrenoreceptor Blockers
SOTALOLTablets 40mg, 80mgNICE Guidelines AF [CG180]
SIGN Guidelines ArrhythmiasAPC traffic light status: GREEN
Injection 40mg in 4ml
Cardiac GlycosidesNOTES
DIGOXINTablets 62.5, 125, 250micrograms

Elixir 50mcg/ml

NICE Guidelines AF [CG180]
SIGN Guidelines Arrhythmias
Therapeutic Drug Monitoring for Digoxin: Take bloods at least 6 hours post-doseTherapeutic Level for AF = 1.0-2.6 nanomoles/litreAPC traffic light status: GREEN
Injection 100mcg/ml
ANTIDOTENOTES
DIGOXIN-SPECIFIC ANTIBODY
On advice of National Poisons Information
40 mg VIAL (DigiFab)Seek advice from National Poisons Centre
http://www.toxbase.org/
YOU WILL NEED A USERNAME AND PASSWORDAPC traffic light status: RED
2 BLEEDING DISORDERS
ANTIHAEMORRHAGICS – AntifibrinolyticsNOTES
TRANEXAMIC ACIDTablets 500mgAPC traffic light status: GREEN

 

Injection 100mg/ml
ANTIHAEMORRHAGICS – haemostaticsNOTES
ETAMSYLATE500 mg TabletsShort term use for menorrhagic blood loss

APC traffic light status: none

2.1 Coagulation factor Disorders
BLOOD AND RELATED PRODUCTS – Coagulation ProteinsNOTES
FACTOR VIII(RECOMBINANT) 500 units InjectionRESTRICTED for HAEMATOLOGY use only

APC traffic light status: none

2.2 Subarachnoid Haemorrhage
NIMODIPINETablets 30mg

Infusion 200mcg/ml (50ml vial)

RESERVED for treatment of subarachnoid haemorrhage 60mg 6x daily (every 4 hours), started within 4 days, continued for 21 days. IV administered via central line only

APC traffic light status: RED

3 BLOOD CLOTS
Anticoagulation Selection Tool PCN August 2017 v5

PNC policy statement – DOACs for Stroke Prevention in AF

SASH guideline – Initiation of oral anticoagulantsSASH guideline – Peri-operative management of oral anticoagulants in patients having elective surgery
NPSA ALERT on oral Anticoagulants – Actions that can make oral anticoagulant therapy safer: Information for patients and carer
NPSA ALERT on oral Anticoagulants – Actions that can make oral anticoagulant therapy safer: Alert and other information
Surrey PCN NOACs Policy StatementNOACS Pathway
3.1 Blocked Catherters and linesNOTES
EPOPROSTENOL (Flolan) Vials 500 microgramsPrescribing should be by a specialist only, in line with NICE and/or local pathways. Commissioned by NHSE  for Pulmonary Arterial Hypertension and CCGs for Raynauld’s Disease.

APC traffic light status: RED

3.2 Thromboembolism
ANTIDOTES AND CHELATORSNOTES
IDARUCIZUMAB Injection 2.5g/50mlRESTRICTED always seek HAEMATOLOGY advice. Kept in Blood Bank
Used for reversal of anticoagulant dabigatran [Pradaxa]
Idarucizumab PRAXBIND SPCAPC traffic light status: RED
ANTIPLATELET DRUGSNOTES
RCP – National clinical guidance for stroke (2012)
MHRA 2014 – Interaction between clopidogrel and PPIs
ASPIRIN Tablets 75mgNICE CG94: Guidelines Unstable angina/NSTEMI

APC traffic light status: GREEN

CLOPIDOGREL Tablets 75mgMHRA – Interaction between clopidogrel and PPIs
NICE Guidelines Unstable angina/NSTEMI [CG94]NICE TA210: Clopidogrel and MR Dipyridamole for prevention of occlusive vascular eventsAPC traffic light status: GREEN
DIPYRIDAMOLETablets 25mg, 100mg

Suspension 50mg in 5ml (SF)

Dose 3-4x daily, used for prophylaxis of thromboembolism associated with prosthetic heart valves

APC traffic light status: none

 Tablets SR 200mgIn addition to above, is also licensed for secondary prevention of ischaemic stroke & TIA (with or without aspirin)
Clopidogrel and MR Dipyridamole for prevention of occlusive vascular events [TA210]APC traffic light status: BLUE
ANTITHROMBOTIC DRUGS – Factor XA Inhibitors 
PCN statement – Oral Anticoagulants in AF
APIXABAN Tablets 2.5mg, 5mgStroke Prevention for non-valvular AF
NICE TA275: Apixaban for preventing stroke and systemic embolism in AF

Surrey PCN NOACs Policy Statement
NOACS Medicines Information BULLETINAPC traffic light status: GREEN
EDOXABAN Tablets 30mg, 60mgNICE TAG Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation

NICE TAG Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism

APC traffic light status: GREEN

FONDAPARINUX PF syringes (5mg/ml) 1.5mg, 2.5mg

PF syringes (12.5mg/ml) 5mg, 7.5mg, 10mg

Routine use in Unstable angina and NSTEMI only

Unlike other LMWH, Fondaparinux is manufactured from a synthetic source. It is suitable for patients who cannot consume animal products for cultural reasons

CAUTION – potential for latex reactions in allergic patients
[prettyfilelink size="" src="https://surreyandsussex.nhs.uk/wp-content/uploads/2013/04/Fondaparinux-for-venous-thromboembolism.pdf" type="pdf"]Fondaparinux for venous thromboembolismNICE Guidance on Unstable angina and NSTEMI [CG94]

SASH Guideline

APC traffic light status: RED

RIVAROXABAN Tablets 10mg

 

 

 

Tablets 15mg, 20mg, 2.5mg

 

 

 

 

 

 

 

 

 

 

 

 

 

Orthopaedic Thromboprohylaxis
Prophylaxis of VTE post knee replacement = 10mg once daily for 2 weeks. Prophylaxis of VTE post hip replacement = 10mg once daily for 5 weeksRivaroxaban Bleeding GuidanceRivaroxaban Conversions NOACS Patient FAQsPCN-NOACs for stroke prevention in AFStroke Prevention for non-valvular AF
NICE TA 256: Rivaroxaban for preventing stroke and systemic embolism in AFNICE TA 261: Rivaroxaban for treatment of DVT/PENICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease

Surrey PCN NOACs Policy Statement
NOACS Pathway Rivaroxaban Shared Care Guidance (Surrey CCGs) Rivaroxaban Bleeding Guidance Rivaroxaban Conversions NOACS Patient FAQsNOACS Medicines Information BULLETINPCN-NOACs for stroke prevention in AFAPC traffic light status: GREEN

ANTITHROMBOTIC DRUGS – Heparins
NICE Quality Standard 3: Venous thromboembolism prevention quality standard 
https://www.sps.nhs.uk/articles/what-factors-should-be-considered-when-using-lmwh-to-treat-venous-thromboembolism-in-patients-with-high-body-weight/
SASH IV heparin guideline
 PROTAMINEInjection 50mg in 5mlRESTRICTED always seek HAEMATOLOGY advice. Used for reversal of heparin overdose.

APC traffic light status: RED

ENOXAPARIN (CLEXANE)PF syringes 20mg, 40mg, 60mg, 80mg, 100mg

PF syringes (Forte) 120mg, 150mg

Pregnancy, Pre-operative / bridging therapy, VTE prevention post hip/knee surgery

PCN statement: Biosimilar enoxaparin use for all licensed indications in adults

PRESCRIBE BY BRAND

APC traffic light status: RED

PF syringes 20mg, 40mg, 60mg, 80mg, 100mg

PF syringes (Forte) 120mg, 150mg

VTE prophylaxis when unable to take warfarin

APC Policy statement: LMWH for VTE treatment (excl obstetrics and chemotherapy)

PRESCRIBE BY BRAND

APC traffic light status: BLUE

PF syringes 20mg, 40mg, 60mg, 80mg, 100mg

PF syringes (Forte) 120mg, 150mg

VTE prophylaxis

PRESCRIBE BY BRAND

APC traffic light status: GREEN

HEPARIN SODIUM5000 units in 0.2ml – 

1000units/ml (20ml)

1000units/ml (1ml)

100 units/ml (1ml)

10 units/ml

1 unit/ml (500ml)

25000units in 5ml

100 units in 1ml 2ml Ampoule Injection

5000units / 0.2ml for VTE prophylaxis in renal impairment

 

RESTRICTED USE For patients with IV catheters in accordance with manufacturer’s instructions

APC traffic light status: none

HEPARIN CALCIUM5000 units in 0.2ml Syringe Subcutaneous InjectionAPC traffic light status: none
ANTITHROMBOTIC DRUGS – Direct Thrombin inhibitorsNOTES
ARGATROBAN MONOHYDRATE Injection 100mg/ml, 2.5ml vialRESTRICTED : ITU or Haematology advice Licensed for HIT Type II
SMC Argatroban
APC traffic light status: RED
BIVALIRUDINInjection 250mgNICE TA 230:  Bivalirudin for the treatment of STEMI

APC traffic light status: RED

DABIGATRAN Tablets 110mg, 150mgStroke Prevention for non-valvular AF
NICE TA249: Dabigatran for preventing stroke and systemic embolism in AFSurrey PCN NOACs Policy StatementNOACS-PathwayDabigatran Shared Care SurreyDabigatran Bleeding GuidanceNOACS-Patient-FAQNOACS-Medicines-Information-BULLETINPCN-NOACs for stroke prevention in AFAPC traffic light status: GREEN
ANTITHROMBOTIC DRUGS – Tissue Plasminogen ActivatorsNOTES
UROKINASE Injection 10,000unitsAPC traffic light status: RED
ANTITHROMBOTIC DRUGS – Vitamin K AntagonistsNOTES
PHENIDIONE Tablets 25mg, 50mgRESTRICTED USE: Consultant only for patients unable to take warfarin

APC traffic light status: BLUE

WARFARIN Tablets 500micrograms (white), 1mg (brown), 3mg (blue)

Tablets 5mg (pink) – RESRICTED (see next column)

 

Therapeutic INR Monitoring Required NPSA Safety Alert on Oral Anticoagulants. Warfarin Prescribing Policy & Target INR based on indication

5mg Tablets RESTRICTED: To patients who are on warfarin doses of 15mg daily or higherNPSA Safety Alert on Oral AnticoagulantsWarfarin Prescribing Policy

Drug Safety Update July 2016 – Reports of Calciphylaxis

APC traffic light status: GREEN

Is there an interaction between warfarin and proton pump inhibitors?

4 BLOOD PRESSURE CONDITIONS
4.1 Hypertension
CENTRALLY ACTING ANTIHYPERTENSIVE DRUGSNOTES
CLONIDINETablets 100micrograms

Injection 150 micrograms/ml

Reserved for severe / resistant hypertension

APC traffic light status: RED

METHYLDOPATablets 125mg, 250mg, 500mgReserved for severe / resistant hypertension Commonly used in pregnancy / maternity

APC traffic light status: RED

BETA-ADRENOCEPTOR BLOCKING DRUGSNOTES
ALpha & Beta andrenoceptor blockers
CARVEDILOLTablets 3.125mg, 6.25mg, 12.5mg, 25mgRESTRICTED for CARDIOLOGIST treatment of heart failure.

Titrate dose increase every 10-14 days. Usual maintenance dose in heart failure 25mg twice daily (50mg twice daily if body weight over 85kg)

APC traffic light status: GREEN

LABETALOLTablets 50mg, 100mg

100mg in 20ml amps

RESTRICTED for specialist use only. Indicated for hypertensive crisis, hypertension following MI and hypertension of pregnancy

APC traffic light status: BLUE

Non-selective Beta andrenoceptor blockers
PROPRANOLOLTablets 10mg, 40mg, 80mg, SR 80mg, SR 160mg

Syrup 5mg in 5ml, (unlicensed) 50mg in 5ml (unlicensed)

APC traffic light status: GREEN
Selective Beta andrenoceptor blockers
ATENOLOLTablets 25mg, 50mg, 100mg

Syrup 25mg/5ml

Injection 5mg/10ml

APC traffic light status: GREEN
BISOPROLOLTablets 1.25mg, 2.5mg, 3.75mg, 5mgRESTRICTED for CARDIOLOGIST when used for treatment of heart failure.

Titrate dose increase every 10-14 days. Usual maintenance dose in heart failure 10mg daily

APC traffic light status: GREEN

ESMOLOL HYDROCHLORIDEInjection 100mg in 10mlRESTRICTED for use on CCU / ITU / Resus / Theatres

Treatment of supraventircular arrhythmias, tachycardias and peri-operative hypertension

APC traffic light status: RED

METOPROLOLTablets 50mg, 100mgAPC traffic light status: GREEN
Injection 5mg in 5ml
CALCIUM CHANNEL BLOCKERSNOTES
NICE Guidance 127: Hypertension Guidelines

What are the reported incidences of ankle oedema with different calcium channel blockers?

https://www.sps.nhs.uk/articles/how-should-ankle-oedema-caused-by-calcium-channel-blockers-be-treated/
How do amlodipine and felodipine compare for the treatment of hypertension or prophylaxis of stable angina?
AMLODIPINETablets 5mg, 10mgAPC traffic light status: GREEN
DILTIAZEMTablets MRUsually dose three times daily

APC traffic light status: GREEN

ADIZEM SRDose twice daily

APC traffic light status: GREEN

ADIZEM XLDose once daily

APC traffic light status: GREEN

TILDIEM SRDose twice daily

APC traffic light status: GREEN

TILDIEM LADose once daily

APC traffic light status: GREEN

NIFEDIPINECapsules 5mg, 10mgUsually dose three times daily

APC traffic light status: GREEN

Tablets SR 10mg, 20mgDose twice daily

APC traffic light status: GREEN

Tablets long-acting 30mgDose once daily

APC traffic light status: GREEN

 VERAPAMILTablets 40mg, 80mg, 120mgNon-modified release preparations of verapamil are usually dose three times daily

APC traffic light status: GREEN

Tablets SR (Half-Securon) 120mg, (Securon) 240mgDose twice daily

APC traffic light status: GREEN

Capsules Prolonged release 180mg (Univer)Dose once daily

APC traffic light status: GREEN

DIURETICSNOTES
NICE Guidance 127: Hypertension Guidelines
Thiazides and Related DiureticsNOTES
BENDROFLUMETHIAZIDETablets 2.5mg, 5mgAPC traffic light status: GREEN
INDAPAMIDETablets 2.5mg, SR 1.5mgCan cause significant hypokalaemia.

APC traffic light status: GREEN

DIAZOXIDE 15mg / ml INJECTIONRESTRICTED for CONSULTANT use only (severe hypertension).

Off-label

APC traffic light status: RED

DRUGS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM –Angiotensin Converting Enzyme (ACE) InhibitorsNOTES
NICE GuidanceNICE Hypertension Guidelines [CG127]
NICE GuidanceNICE Guidance on Chronic Heart Failure [CG108]
MHRA Safety AlertRisk of potentially fatal hyperkalaemia with spironolactone – Dec 2016
CAPTOPRILTablets 12.5mg, 25mg, 50mgLicense = Hypertension, CCF/heart failure, Post-MI (with LVSD) and Diabetic Nephropathy Useful for test doses Short-half life requires twice daily/three times daily dosing
ENALAPRIL MALEATETablets 2.5mg, 5mg, 10mg, 20mg tabletsLicense = Hypertension, CCF (symptomatic) and Prevention of CFF in patients with LVSD

APC traffic light status: GREEN

LISINOPRILTablets 2.5mg, 5mg, 10mg, 20mgLicense = Hypertension, CCF, Post-MI (with or without heart failure), Diabetic Nephropathy (type 1 & type 2)

APC traffic light status: GREEN

PERINDOPRIL erbumineTablets 2mg, 4mg, 8mgLicense = Hypertension and CCF (symptomatic)

APC traffic light status: GREEN

RAMIPRILCapsules 2.5mg, 5mg, 10mgLicense = Hypertension, Post-MI (with CCF) and Prevention of CV events in over 55yr (MI, stroke, CVdeath & revascularisation)

APC traffic light status: GREEN

ANGIOTENSIN-II RECEPTOR ANTAGONISTSNOTES
CANDESARTANTablets 2mg, 4mg, 8mg, 16mgFormulary Angiotensin II Antagonist of choice is Candesartan

APC traffic light status: GREEN

LOSARTANTablets 25mg, 50mg, 100mgAPC traffic light status: GREEN
VASODILATOR ANTIHYPERTENSIVE DRUGSNOTES
HYDRALAZINETablets 50mgReserved for severe / resistant hypertension

APC traffic light status: BLUE

ALPHA-ADRENOCEPTOR BLOCKING DRUGSNOTES
DOXAZOSINIR Tablets 1mg, 2mg, 4mg,APC traffic light status: GREEN

Switching from doxazosin XL tablets to doxazosin standard release tablets

INDORAMINTablets 25mgAPC traffic light status: none
PHENTOLAMINE MESYLATEInjection 10mg in 1ml UNLICENSED
PRAZOSINTablets 500mcg, 1mg, 2mgAPC traffic light status: none
4.1a Hypertension associated with phaeochromocytoma
VASODILATORS – Peripheral vasodilatorsNOTES
PHENOXYBENZAMINE10 mg Capsules

50mg / ml Injection

Reserved for hypertension associated with phaeochromocytoma Maintenance usually co-prescribed with beta-blockers

APC traffic light status: none

4.1b Hypertensive Crises
ANTIADRENERGIC AGENTS – Peripherally actingNOTES
GUANETHIDINEInjection 10mg in 1ml No longer recommended for hypertensive crisis
VASODILATORS – Vasodilator antihypertensivesNOTES
SODIUM NITROPRUSSIDE Injection 50mgRESTRICTED for use on CCU / ITU / Resus / Theatres

Treatment of hypertensive crisis and controlled hypertension in anaesthesia

Unlicensed product

4.2 Hypotension and shock
SYMPATHOMIMETICS – InotropicNOTES
DOPAMINEInjection 200mg in 5ml
SYMPATHOMIMETICS -Vasoconstrictor NOTES
METARAMINOLInjection 2.5mg in 5ml UNLICENSED
MIDODRINETablet 2.5mg, 5mgIndication – Severe orthostatic hypotension

APC traffic light status: BLUE

NOREPINEPHRINE / NORADRENALINE ACID TARTRATE2 mg in 2ml Injection(equivalent to noradrenaline 1mg / ml)
PHENYLEPHRINE10mg in 1ml (1%) injection
6 HEART FAILURE
DIURETICS – Potassium Sparing Diuretics – Aldosterone antagonistsNOTES
EPLERENONETablets 25mg, 50mgRESTRICTED For Post-MI patients with Cardiac Failure
NICE Guidelines MI Secondary Prevention CG172
SMC Eplerenone [Accepted]
SIGN Management of Chronic Heart FailureAPC traffic light status: BLUE
SPIRONOLACTONETablets 25mg, 50mg, 100mg

Solution (unlicensed) 10mg in 5ml, 50mg in 5ml

 Safety alert Dec 2016 – risk of potentially fatal hyperkalaemia with ACEi or ARB

APC traffic light status: GREEN

DRUGS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM – Angiotensin II Receptor Antagonists
SACUBITRIL VALSARTANTablets 24/26mg, 49/51mg, 97/103mgRefer to Shared Care Guidance

NICE TA 390

Do not co-administer with an ACEi or ARB. Due to potential risk of angioedema when used concomitantly with an ACEi, it must not be started for at least 36 hours after discontinuing ACEi

APC traffic light status: AMBER

PhosphodiesteraseType 3 InhibitorsNOTES
MILRINONE 10 mg InjectionRESTRICTED ITU only For use in unresponsive heart failure

APC traffic light status: RED

7 HYPERLIPIDAEMIA
NICE GuidanceNICE Lipid Modification Guideline [CG181]
Local policy (Surrey PCN)Lipid Management Algorithm for prevention of CPD
LIPID MODIFYING DRUGS – Bile acid sequestrantsNOTES
COLESTYRAMINE/ COLESTYRAMINE LIGHT 4g sachets Not recommended for prevention of cardiovascular disease [NICE CG181] (‘Black’ for this indication in primary care)

Patients with Familial hypercholesterolaemia who are intolerant or have contra-indications to statins or ezetimibe should be offered a referral to a specialist for consideration of treatment with either a bile acid sequestrant (resin), nicotinic acid or a fibrate to reduce their LDL-C concentration [NICE CG 71]

APC traffic light status: BLUE

LIPID MODIFYING DRUGS – Cholesterol absorption inhibitorsNOTES
EZETIMIBE Tablets 10mgEzetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia (NICE TA385)

Summary of NICE Guidance on the use of Statins and Ezetimibe in adults [KTT3]

Lipid modification: cardiovascular risk assessmentand the modification of blood lipids for the primary and secondary prevention of cardiovascular disease [CG181]

APC traffic light status: GREEN

LIPID MODIFYING DRUGS – FibratesNOTES
Fibrates should not routinely be used for prevention of CVD [NICE CG181] (‘Black’ for this indication in primary care)

 

May be useful in treatment of specific groups of people, particularly those with hypertriglyceridemia (>10mmol/l) or familial hypercholesterolaemia (as per NICE CG71)

BEZAFIBRATE Tablets 200mg

SR Tablets 400mg

APC traffic light status: BLUE
FENOFIBRATE Capsules (micronised) 200mgAPC traffic light status: BLUE
STATINSNOTES
Medicines Q & AStatins in renal impairment
Medicines Q & A

Is there an interaction between erythromycin and statins?

MHRA Drug Safety UpdateStatins: benefits and risks [2014]
MHRA Drug Safety UpdateStatins: risk of hyperglycaemia and diabetes [2012]
ATORVASTATINTablets 10mg, 20mg, 40mg, 80mgFirst line for primary and secondary prevention of CVD

APC traffic light status: GREEN

ROSUVASTATIN Tablets 5mg, 10mg Not cost-effective. Option if high-intensity statin needed but alternatives not tolerated

APC traffic light status: GREEN

SIMVASTATIN Tablets 20mg, 40mgAPC traffic light status: GREEN
PCSK9 INHIBITORS
ALIRCUMAB PF pen 75mg, 150mgNICE TA 393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia

Restricted use – to be prescribed by lipidologist only as per NICE TA

APC traffic light status: RED

EVOLOCUMAB PF pen 140mgNICE TA 394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia

Restricted use – to be initiated by lipidologist only as per NICE TA

APC traffic light status: RED

7 MYOCARDIAL ISCHAEMIA
Stable Angina
Piperazine InhibitorsNOTES
RANOLAZINEMR Tablets 375mg, 500mg, 750mg RESTRICTED to CARDIOLOGY initiation  only

Refer to shared care guidance

APC traffic light status: AMBER

Selective Sinus Node If InhibitorsNOTES
IVABRADINETablets 5mg, 7.5mgRESTRICTED to CARDIOLOGY initiation only

Refer to Blue (amber star) information sheet

NICE TAG Ivabradine Heart Failure[TA267]
SMC Ivabradine Heart Failure

 

NICE Guidance on Management of stable angina [CG126]
SMC Ivabradine Angina

APC traffic light status: BLUE

ANTITHROMBOTIC DRUGS – Antiplatelet drugsNOTES
NICORANDILTablets 10mg, 20mgAPC traffic light status: GREEN
7.1 ACUTE CORONARY SYNDROMES
VASODILATORS – Potassium channel openersNOTES
PRASUGRELTablet 5mg, 10mgRefer to Blue information sheet

NICE TA 317: Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes

APC traffic light status: BLUE

TICAGRELOR Tablets 90mgRestricted to CARDIOLOGY team Only

Refer to Blue information sheet

NICE TA 236: Ticagrelor for the treatment of acute coronary syndromes

NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction

APC traffic light status: BLUE

ANTITHROMBOTIC DRUGS – Tissue Plasminogen ActivatorsNOTES
NICE TA Thrombolysis in acute MIGuidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction [TA52]
ALTEPLASE Injection 50mgNICE TA 264: Alteplase for treating acute ischaemic stroke

SASH – Acute Stroke PathwayAcute Stroke Unit Policy-Hypertension in 24 hours of thrombolysisAcute Stroke Unit Policy-Anaphylaxis post thrombolysisAcute Stroke Unit Policy-Extracranial bleeding post thrombolysis

APC traffic light status: RED

STREPTOKINASEInjection 100000 units, 250000 units, 1.5 million unitsAPC traffic light status: RED
TENECTEPLASE Injection 40mg (8,000 units) 50mg (10,000 units) InjectionAPC traffic light status: RED
NITRATESNOTES
GLYCERYL TRINITRATESublingual Spray 400mcgAPC traffic light status: GREEN
Patches 5mg/24 hours, 10mg/24 hours
Injection 50mg in 50ml
ISOSORBIDE MONONITRATETablets 10mg, 20mg

MR tablets 60mg

IR To be dosed 2-3x DAILY, with last dose no later than 4pm

MR tablet can be halved

APC traffic light status: GREEN

SYMPATHOMIMETICS – InotropicNOTES
DOBUTAMINEInjection 250mg in 20ml
7.1a CARDIAC ARREST
SYMPATHOMIMETICS – VasoconstrictorNOTES
EPINEPHRINE / ADRENALINE1mg in 10ml 1 in 10000 MINIJET

1mg in 10ml (1 in 10000) Injection & syringe

1mg in 1ml (1 in 1000) Injection & syringe

5mg in 5ml (1 in 1000) Injection

8 Oedema
LOOP DIURETICSNOTES
NICE GuidanceNICE Hypertension Guidelines [CG127]
NICE GuidanceNICE Guidance on Chronic Heart Failure [CG108]
BUMETANIDETablets 1mg, 5mgAPC traffic light status: GREEN
0.5mg/ml InjectionUnlicensed
CO-AMILOFRUSE (Amiloride/Furosemide)Tablets 5mg/40mg, 2.5mg/20mgAPC traffic light status: GREEN
FUROSEMIDETablets 20mg, 40mg

Solution 50mg in 5ml

(solution is unlicensed)

APC traffic light status: GREEN

Injection 20mg/2ml
OSMOTIC DIURETICSNOTES
MANNITOL10% 500ml

20% 500ml

Used in cerebral oedema usual rate 1g/kg.

Precede with test dose of 200gm/kg by slow IV injection.

POTASSIUM-SPARING DIURETICS – otherNOTES
AMILORIDETablets 5mg

Solution 5mg in 5ml

APC traffic light status: GREEN
DIURETICS – Thiazides and related diureticsNOTES
METOLAZONETablets 5mgReserved for resistant oedema/heart failure

Dose 2 or 3 times weekly, used in conjunction with thiazide.

Unlicensed product

9 VASCULAR DISEASE
NAFTIDROFURYLCapsules 100mgAPC traffic light status: GREEN
PENTOXIFYLLINETablets 400mgAPC traffic light status: BLACK

Cilostazol, Naftidofuroyl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral artierial disease [TA223]

9.1 Vein Malformations
LOCAL SCLEROSANTSNOTES
SODIUM TETRADECYL SULFATE 0.2%, 0.5%, 1%, 3% solution for injectionSclerotherapy of reticular veins and spider veins in legs and varicose veins
ETHANOLAMINE OLEATE(5mL) 5 % InjectionRESTRICTED for use in treatment of variceal haemorrhage (sclerosing agents) (refer to pharmacy, varying licenses)
BNF CODE – 2.7.2
EPHEDRINEInjection 30mg in 10ml (syringe), 30mg in 1ml

 

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