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 Formulary Chapter 2: Cardiovascular system - Full Chapter
Notes:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

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 Details...
02.05.01  Expand sub section  Vasodilator antihypertensive drugs
Bosentan tabs (digital ulcer disease - off-label)
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Restricted Drug Restricted
Red
High Cost Medicine

INITIATION BY SPECIALIST ONLY

Last-line option, to reduce the number of new digital ulcers in patients with systemic sclerosis and ongoing digital ulcer disease, who:

  • Have a history of multiple digital ulcers
  • Have previously failed treatment with iloprost
  • Use in accordance with local guideline
 
   
Bosentan tabs (Fontan circulation - off-label)
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Restricted Drug Restricted
Red

Approved off-label indication:

Patients with a failing Fontan circulation

Restricted use in patients where there is a suggestion of segmental pulmonary arterial hypertension or failing Fontan only after full discussion and approval from the pulmonary hypertension and congenital heart disease MDT.

Dose = Bosentan 62.5 mg to 125 mg twice a day.

 
   
Hydralazine tabs, injection
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Formulary  
   
Minoxidil tabs
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Restricted Drug Restricted
Amber 2
USE ON SPECIALIST ADVICE ONLY 
   
Sildenafil tabs (as 25mg tablets)
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Restricted Drug Restricted

Approved off-label indication:

Raynaud’s secondary to scleroderma in patients that are contraindicated to or have failed other treatment options

  • Use in accordance with local guideline
  • RESTRICTED USE – CONSULTANT SPECIALISTS ONLY
 
   
Sildenafil tabs - generic (Fontan circulation - off-label)
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Restricted Drug Restricted
Red

Approved off-label indication:

Patients with a failing Fontan circulation

Restricted use in patients where there is a suggestion of segmental pulmonary arterial hypertension or failing Fontan only after full discussion and approval from the pulmonary hypertension and congenital heart disease MDT.

Dose = Sildenafil 12.5mg to 100mg three times a day.

Only generic sildenafil tablets should be supplied for this indication.

 
   
Sildenafil tabs - generic (pulmonary hypertension)
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Restricted Drug Restricted
Red

Approved off-label indication:

Initiation of treatment in pulmonary hypertension following discussion with local specialist centre (Royal Free Hospital)

Dose = 25 mg to 100 mg three times a day

 
   
Diazoxide injection
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Formulary
Red
 
   
Iloprost injection
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Unlicensed Drug Unlicensed
Red

RESTRICTED USE - CONSULTANT SPECIALIST ONLY

Treatment of digital ulcer disease

Use in accordance with local guideline

 
   
Iloprost injection  (severe peripheral artery disease)
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Unlicensed Drug Unlicensed
Red

USE UNDER SPECIALIST SUPERVISION ONLY

  • Treatment of severe peripheral arterial occlusive disease, particularly those at risk of amputation and in whom surgery or angioplasty is not possible
  • Treatment of severe Raynaud’s phenomenon unresponsive to other therapies
  • Treatment of advanced thromboangiitis obliterans (Buerger’s disease) with critical limb ischaemia where revascularisation is not indicated

Use in accordance with local guideline

 
   
Sodium nitroprusside injection
Unlicensed Drug Unlicensed
Red

USE ON SPECIALIST ADVICE ONLY

Approved as 2nd line treatment of life-threatening hypertension in intensive care units. First line treatment is labetalol.

 
   
Papaverine injection
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Unlicensed Drug Unlicensed
Red

RESTRICTED USE – CONSULTANT SPECIALISTS ONLY

As an intrathecally administered adjunct treatment during aortic aneurysm repair

Use in accordance with local guideline

 
   
 ....
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
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Link to adult 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

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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