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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.06.03  Expand sub section  Other antianginal drugs
Ivabradine
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Formulary
Green 3
Tablets


Restricted ItemáSpecialist 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 ItemáRestricted 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
       
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    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
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    Link to adult BNF
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    Link to children's BNF
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    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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