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2. Cardiovascular System

NICE CG172: MI – Secondary Prevention

Other NICE Cardiovascular Guidelines are available via this link 

Digoxin
BNF | BNFC | SPC

62.5microgram, 125microgram, 250microgram Tablets

50microgram/ml Elixir

Bendroflumethiazide
BNF | BNFC | SPC

2.5mg, 5mg Tablets

Indapamide
BNF | BNFC | SPC

2.5mg Tablets

Bumetanide
BNF | BNFC | SPC

1mg, 5mg tablets

Furosemide
BNF | BNFC | SPC

20mg, 40mg Tablets

20mg/5ml, 40mg/5ml, 50mg/5ml Sugar Free Oral Solution

Torasemide
BNF | BNFC | SPC

2.5mg, 5mg and 10mg tablets

3rd line after furosemide and bumetanide

Amiloride
BNF | BNFC | SPC

5mg Tablets

5mg/5ml Oral Solution

Eplerenone
BNF | BNFC | SPC

25mg, 50mg Tablets

Please set up recall for potassium monitoring on initiation, as per South Tees HFT Cardiology guidelines

Spironolactone
BNF | BNFC | SPC

25mg, 50mg, 100mg Tablets

Please set up recall for potassium monitoring on initiation, as per South Tees HFT Cardiology guidelines

 

 

Mannitol
BNF | BNFC | SPC

Tariff Excluded; NHSE Commissioned

Approved: NICE TA266

Amiodarone
BNF | BNFC | SPC

100mg, 200mg Tablets

Initiated and titrated to maintainence dose only under specialist supervision

Dronedarone
BNF | BNFC | SPC

400mg Tablets

Shared Care

Cardiology Shared Care Guideline

NICE TA197 As recommended by NICE approved for patients who are unsuitable for or not tolerant of amiodarone. Treatment is to be initiated by cardiologists. 

Flecainide
BNF | BNFC | SPC

50mg, 100mg Tablets

200mg MR Capsules (Tambocor XL)

Initiated and titrated to maintainence dose only under specialist supervision

Propafenone
BNF | BNFC | SPC

150mg, 300mg Tablets

Initiated and titrated to maintainence dose only under specialist supervision

Atenolol
BNF | BNFC | SPC

25mg, 50mg, 100mg Tablets

25mg/5ml Sugar Free Oral Solution

Bisoprolol
BNF | BNFC | SPC

1.25mg, 2.5mg, 3.75mg, 5mg, 7.5mg, 10mg Tablets

Carvedilol
BNF | BNFC | SPC

3.125mg 6.25mg, 12.5mg, 25mg Tablets

Metoprolol
BNF | BNFC | SPC

50mg, 100mg Tablets

Nebivolol
BNF | BNFC | SPC

Use 5mg or 10mg Tablets

5mg tablets can be halved or quartered

 

Propranolol
BNF | BNFC | SPC

10mg, 40mg, 80mg Tablets

5mg/5ml, 10mg/5ml, 40mg/5ml, 50mg/5ml Sugar Free Oral Solution

Sotalol
BNF | BNFC | SPC

40mg, 80mg, 160mg Tablets

Specialist initiation only

Ambrisentan
BNF | BNFC | SPC

Pulmonary Arterial Hypertension

Hydralazine
BNF | BNFC | SPC

25mg Tablets

Iloprost
BNF | BNFC | SPC

PPH; Raynaud's phenomenon

Sildenafil
BNF | BNFC | SPC

Treatment of pulmonary hypertension (in accordance with NHSE commissioning policy) and secondary Raynaud’s disease

Doxazosin
BNF | BNFC | SPC

1mg, 2mg, 4mg Tablets

Standard release tablets only not MR

Doxazosin Modified Release Preparations
BNF | BNFC | SPC

Tees Do Not Prescribe/Grey List

There is no good evidence of additional benefit over immediate release doxazosin.  Both formulations provide effective blood pressure control and are effective at controlling the symptoms of BPH and improving maximum urinary flow rate. Half-life of immediate release doxazosin is about 22 hours, allowing once daily dosing.

MHRA Drug Safety Update (June 2014):  Combination use of medicines from different classes of renin-angiotensin system blocking agents: risk of hyperkalaemia, hypotension, and impaired renal function—new warnings

Lisinopril
BNF | BNFC | SPC

2.5mg, 5mg, 10mg, 20mg Tablets

Perindopril arginine
BNF | BNFC | SPC

Tees Do Not Prescribe/Grey List

No evidence of benefit over generic perindopril erbumine and is more costly. Coversyl(R) prescribed by brand name will be dispensed as Coversyl(R) Arginine.

PrescQIPP briefing 59: Perindopril arginine

Perindopril erbumine
BNF | BNFC | SPC

2mg, 4mg, 8mg Tablets

Ramipril
BNF | BNFC | SPC

1.25, 2.5mg, 5mg, 10mg Capsules and Tablets

Trandolapril / Verapamil (Tarka)
BNF | BNFC | SPC

Second line in patients who have tried and were unable to tolerate at least two ACE inhibitors. 

Candesartan
BNF | BNFC | SPC

2mg, 4mg, 8mg, 16mg, 32mg Tablets

 

Losartan
BNF | BNFC | SPC

12.5mg, 25mg, 50mg, 100mg Tablets

 

Valsartan
BNF | BNFC | SPC

40mg, 80mg, and 160mg CAPSULES

Sacubitril Valsartan
BNF | BNFC | SPC

NICE TA388 - First 3 months from Trust

Tees Sacubitril Valsartan Prescribing Guidance

Sacubitril 24mg / Valsartan 26mg tablets

Sacubitril 49mg / Valsartan 51mg tablets

Sacubitril 97mg / Valsartan 103mg tablets

 

Aliskiren
BNF | BNFC | SPC

Tees Do Not Prescribe/Grey List

NICE CG127 states that there is insufficient evidence of its cost effectiveness to determine its suitability for use in resistant hypertension

Glyceryl Trinitrate
BNF | BNFC | SPC

400micrograms/metered dose Pump Spray

180 dose, 200 dose

Isosorbide Mononitrate
BNF | BNFC | SPC

10mg, 20mg, 40mg Tablets 

Amlodipine
BNF | BNFC | SPC

5mg, 10mg Tablets

Diltiazem
BNF | BNFC | SPC

MR Tablets 60mg 

MR Tablets/Capsules (BD preparations) 90mg, 120mg, 180mg

MR Tablets/Capsules (OD preparations) 120mg, 180mg, 240mg, 300mg, 360mg.

Different versions of modified release diltiazem containing more than 60mg may not have the same clinical effect. Specify brand to avoid confusion

Verapamil
BNF | BNFC | SPC

Tablets 40mg, 80mg, 120mg

MR Tablets/capsules 120mg and 240mg

 

 

Ivabradine
BNF | BNFC | SPC

5mg, 7.5mg Tablets

Consultant cardiologist initiation only

Approved for use in line with NICE TA267

MHRA Dec 2014: Ivabradine (Procoralan) in the symptomatic treatment of angina: risk of cardiac side effects

Nicorandil
BNF | BNFC | SPC

10mg, 20mg Tablets

MHRA Drug Safety Update

Ranolazine
BNF | BNFC | SPC

375mg MR, 500mg MR, 750mg MR Tablets

Specialist recommendation only.

Cilostazol
BNF | BNFC | SPC
Inositol nicotinate
BNF | BNFC | SPC

Not Approved: NICE TA223

Naftidrofuryl
BNF | BNFC | SPC

100mg capsules

Approved: NICE TA223

 

Pentoxifylline
BNF | BNFC | SPC
Epoprostenol
BNF | BNFC | SPC

Primary Pulmonary Hypertension

Fondaparinux
BNF | BNFC | SPC

Unstable angina / NSTEMI

Danaparoid
BNF | BNFC | SPC

Prevention of DVT in general or orthopaedic surgery

Thromboembolic disease in patients with history of heparin-induced thrombocytopenia

Bivalirudin
BNF | BNFC | SPC

Approved: NICE TA230

Enoxaparin
BNF | BNFC | SPC

40mg/0.4ml, 60mg/0.6ml, 80mg/0.8ml, 100mg/1ml, 120mg/0.8ml and 150mg/1ml injection solution.

This drug is Amber (to be initiated in secondary care), but there is no Shared Care protocol to follow

Tinzaparin
BNF | BNFC | SPC

10,000units/ml as 2500unit, 3500unit, 4500unit, 20,000unit Syringes

This drug is Amber (to be initiated in secondary care), but there is no Shared Care protocol to follow

MHRA Warning: Risk of serious haemorrhage with dabigatran, rivaroxaban & apixiban

Acenocoumarol
BNF | BNFC | SPC

1mg tablets

Apixaban
BNF | BNFC | SPC

2.5mg, 5mg Tablets

Approved: NICE TA245TA275, TA341

Dabigatran
BNF | BNFC | SPC

75mg, 110mg and 150mg Tablets

NICE Guidance: NICE TA157, NICE TA249, NICE TA327

MHRA safety warning: contraindicated in patients with prosthetic heart valve(s) requiring anti-coagulant treatment, because of the risk of thrombosis and haemorrhage

Edoxaban
BNF | BNFC | SPC

15mg, 30mg and 60mg Tablets

Approved in line with NICE TA354 TA355

 

 

Idarucizumab
BNF | BNFC | SPC

Reversal agent for dabigatran

Rivaroxaban
BNF | BNFC | SPC

2.5mg, 10mg, 15mg, 20mg Tablets

Approved: NICE TA170, TA261, TA256TA287, TA335

MHRA Drug Safety Update

Warfarin
BNF | BNFC | SPC

500micrograms(white), 1mg (brown), 3mg(blue), 5mg(pink) Tablets

 

 

NICE CG172: MI – Secondary Prevention

Aspirin
BNF | BNFC | SPC

75mg Dispersible Tablets

Clopidogrel
BNF | BNFC | SPC

75mg, 300mg Tablets

NICE TA210

MHRA Alert (December 2013): risk of acquired haemophilia with clopidogrel

Dipyridamole modified release
BNF | BNFC | SPC

200mg capsules

NICE TA210

Prasugrel
BNF | BNFC | SPC

5mg, 10mg Tablets

Specialist initiation only post PCI.  Use for up to 12 months following PCI.

NICE TA317

MHRA Alert (January 2014): increased risk of bleeding – advice around timing of loading dose for prasugrel

Ticagrelor
BNF | BNFC | SPC

60mg, 90mg Tablets

Approved in line with NICE TA236 Use for up to 12 months following cardiac event.

Approved in line with NICE TA420 Use for up to 3 years in patients following myocardial infarction and who are at high risk of a further event

 

Etamasylate
BNF | BNFC | SPC

Less effective than other treatments in the management of heavy menstrual bleeding

Tees Do Not Prescribe/Grey List

Guideline for lipid modification in primary and secondary prevention of CVD:

NICE CG172: MI – Secondary Prevention

Alirocumab
BNF | BNFC | SPC

Tariff Excluded; CCG Commissioned

Approved: NICE TA393

Ezetimibe
BNF | BNFC | SPC

10mg Tablets

Approved: NICE TA385

 

Evolocumab
BNF | BNFC | SPC

Tariff Excluded; CCG Commissioned in primary hypercholesterolaemia and mixed dyslipidaemia. NHSE Commissioned in homozygous familial hypercholesterolaemia (Specialist centres only)

Approved: NICE TA394

Colesevelam
BNF | BNFC | SPC

625mg tablets

Red if used for GI complications of Revlimid treatment

Colestyramine (Cholestyramine)
BNF | BNFC | SPC

4g oral powder sugar free sachets

Bezafibrate
BNF | BNFC | SPC

200mg Tablets

400mg MR Tablets

Fenofibrate
BNF | BNFC | SPC
Omega-3 and other fish oils
BNF | BNFC | SPC

Tees Do Not Prescribe/Grey List

NICE do not recommend for secondary prevention of MI.

NICE CG172: "Do not offer or advise people use omega-3 fatty acid capsules or omega 3 fatty acid supplemented foods to prevent another MI.” “Advise people to eat a Mediterranean-style diet (more bread, fruit, vegetables and fish; less meat; and replace butter and cheese with products based on plant oils)”

NICE CG87: “Do not prescribe fish oil preparations for the primary prevention of cardiovascular  disease in people with type 2 diabetes"

NICE CG170: “Do not use omega-3 fatty acids to manage sleep problems in children and young people with autism”

NICE do not recommend fish or algal oils solely with the aim of preventing hypertensive disorders in pregnancy or omega-3 fatty acid supplements for familial hypercholesterolaemia

PrescQIPP bulletin 47: Omega-3 fatty acids

Atorvastatin
BNF | BNFC | SPC

10mg, 20mg, 40mg, 80mg Tablets

1st line statin choice as per NICE guidelines

Pravastatin
BNF | BNFC | SPC

10mg, 20mg, 40mg Tablets.

 

Simvastatin
BNF | BNFC | SPC

10mg, 20mg, 40mg Tablets

 

Simvastatin / Ezetimibe (Inegy)
BNF | BNFC | SPC