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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.06  Expand sub section  Nitrates, calcium-channel blockers, and potassium-channel activators
02.06.01  Expand sub section  Nitrates
Glyceryl Trinitrate
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Formulary Spray
Sublingual Tablets
Patches
Injection

 
Link  PAT Continuous Infusion Charts (cardiology)
   
Isosorbide Mononitrate
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Formulary Modified release tablets
Tablets

 
   
Isosorbide Dinitrate
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Formulary Injection

 
   
02.06.02  Expand sub section  Calcium-channel blockers
Amlodipine
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First Choice Tablets 
Diltiazem
(angina)
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First Choice Standard tablets (60mg)
Modified release tablets
Modified release capsules

Specify the brand when prescribing a diltiazem preparation (except for 60mg tablet).

 
Verapamil
(rate controlled atrial fibrillation)
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First Choice Standard tablets
Modified release tablets
Modified release capsules
Injection

 
Lercanidipine
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Second Choice Tablets
 
   
Nifedipine
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Formulary Modified release capsules
Standard release capsules Restricted Item Raynauds phenomenon. Not recommended for angina prophylaxis or hypertension

Specify the brand when prescribing a modified release nifedipine preparation.

Short-acting formulations of nifedipine are not recommended for angina or long-term management of hypertension; their use may be associated with large variations in blood pressure and reflex tachycardia. (BNF) 
   
Nimodipine (Nimotop®)
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Formulary Tablets
Intravenous Infusion

Restricted ItemFor prevention (oral) and treatment (IV) of ischaemic neurological deficits following aneurysmal subarachnoid haemorrhage.  
   
02.06.03  Expand sub section  Other antianginal drugs
Ivabradine
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Formulary
Green 3
Tablets


Restricted Item Specialist initiation

Ivabradine should only be initiated in people with NYHA class II to IV stable chronic heart failure with systolic dysfunction who:
  • are in sinus rhythm with a heart rate of 75 bpm or more
  • have a left ventricular ejection fraction of 35% or less, AND
  • who have been stable for 4 weeks on optimised standard therapy with ACE inhibitors, beta-blockers and aldosterone antagonists (or when beta-blockers are contra-indicated or not tolerated).
  •  
    Link  NICE TA 267: Ivabradine
       
    Ranolazine (Ranexa®)
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    Formulary
    Green 2
    Tablets

    Restricted Item Restricted to cardiac services (PAHT)

    For stable angina where patients are unsuitable for physical therapy or first and second line agents (PAHT).  
       
    Nicorandil (Ikorel®)
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    Formulary Tablets

    Indicated for stable angina only in patients whose angina is inadequately controlled by first-line anti-anginal therapies, or who have a contra-indication or intolerance to first-line therapies, such as beta-blockers and/or calcium channel blockers.  
    Link  MHRA Safety Alert: Risk of ulcer complications
       
    02.06.04  Expand sub section  Peripheral vasodilators and related drugs to top
    Naftidrofuryl Oxalate
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    Formulary Tablets

    Naftidrofuryl is an option for the treatment of intermittent claudication in people with peripheral arterial disease for whom vasodilator therapy is considered appropriate after taking into account other treatment options. See NICE TA223: Peripheral Arterial Disease. 
       
    Pentoxifylline (Trental®)
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    Formulary Tablets

    Restricted Item For alcoholic liver disease.

    Not recommended for the treatment of intermittent claudication in patients with peripheral arterial disease, but patients currently taking pentoxifylline should have the option to continue until they and their clinican considers it appropriate to stop. (NICE TA223:Peripheral Arterial Disease) 
       
    02.06.04  Expand sub section  Other preparations used in peripheral vascular disease
     ....
     Non Formulary Items
    Amlodipine and Valsartan  (Exforge®)

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    Non Formulary
     
    Cilostazol  (Pletal®)

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    Non Formulary Not recommended for the treatment of intermittent claudication in patients with peripheral arterial disease. BUT, patients currently taking cilostazol should have the option to continue until they and their clinican consider it appropriate to stop. (NICE TA 223: Peripheral Arterial Disease)
     
    Felodipine

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    Non Formulary Modified release tablets

    Not GMMMG
     
    Inositol Nicotinate  (Hexopal®)

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    Non Formulary Not recommended for the treatment of intermittent claudication in patients with peripheral arterial disease. BUT, patients currently taking inositol nicotinate should have the option to continue until they and their clinican consider it appropriate to stop. (NICE TA223:Peripheral Arterial Disease)
     
    Isosorbide Dinitrate

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    Non Formulary Tablets
    MR Tablets
    Aerosol Spray
     
    Isradipine  (Prescal®)

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    Non Formulary
     
    Lacidipine

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    Non Formulary Tablets

    Not GMMMG
     
    Moxisylyte  (Opilon®)

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    Non Formulary
     
    Nicardipine

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    Non Formulary Tablets

    Not GMMMG
     
    Nisoldipine  (Syscor® MR)

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    Non Formulary
     
    Oxerutins  (Paroven®)

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    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

    Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

    Black

    These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

    Green

    Not used   

    Green 1

    Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

    Green 2

    Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

    Green 3

    Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

    Grey

    Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

    Red

    Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

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