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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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Unlicensed Drug Unlicensed
Red
USE UNDER SPECIALIST SUPERVISION ONLY Treatment of life-threatening ventricular arrhythmias 
   
Ajmaline injection
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Unlicensed 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
Unlicensed 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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Unlicensed 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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Unlicensed
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NHS England
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Traffic Light Status Information

Status Description

Red

Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. 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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