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Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.03.02  Expand sub section  Drugs for arrhythmias
 note 

In all acute tachycardias with a wide QRS complex, it is advisable to seek expert advice unless the precise nature of the arrhythmia is known. The use of the incorrect drug in these circumstances is dangerous.


Adenosine can be helpful diagnostically in this setting because its shorter action makes it relatively safe. Failure of the tachycardia to respond suggests that it is ventricular rather than supraventricular

02.03.02  Expand sub section  Supraventricular arrhythmias
02.03.02  Expand sub section  Supraventricular and ventricular arrhythmias
02.03.02  Expand sub section  Ventricular arrhythmias
Lidocaine injection

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Restricted Drug Restricted USE UNDER SPECIALIST SUPERVISION ONLY
   
Mexiletine injection

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Restricted Drug Unlicensed
Red
USE UNDER SPECIALIST SUPERVISION ONLY

Treatment of life-threatening ventricular arrhythmias
   
Ajmaline injection

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Restricted Drug Unlicensed Diagnostic test for Brugada syndrome
Dose: 1 mg/kg (actual body weight) up to a maximum dose of 100 mg
   
Hydroquinidine slow release caps

Restricted Drug Unlicensed
Red
CARDIAC ARRHYTHMIA SPECIALIST USE ONLY
For prevention of recurrent vetricular fibrillation (VF) in Brugada syndrome and short-coupled idiopathic VF

Dose: 600 mg to 900 mg daily in divided doses
   
Mexiletine caps

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Restricted Drug Unlicensed
Red
USE UNDER SPECIALIST SUPERVISION ONLY

Treatment of congenital myotonia

Dose: initiate at 1.5mg/kg (usually 2-3 diveded doses) and increase to 10mg/kg (maximum daily dose of 600mg)
   
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Traffic Light Status Information

Status Description
  Red   Specialist Prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   
  Amber 1   Treatment can be initiated in primary care after a recommendation from an appropriate specialist  
  Amber 2   Specialist initiation followed by maintenance prescribing in primary care  
  Amber 3   Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  
  Green   Specialist and non-specialist initiation  
  Grey   Not recommended for prescribing  

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