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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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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
High Cost Medicine

RESTRICTED USE - CONSULTANT SPECIALIST ONLY

Treatment of digital ulcer disease

Use in accordance with local guideline

 
   
Iloprost injection
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Unlicensed Drug Unlicensed
Red
High Cost Medicine
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 Raynaudís phenomenon unresponsive to other therapies
  • Treatment of advanced thromboangiitis obliterans (Buergerís disease) with critical limb ischaemia where revascularisation is not indicated  
  •    
    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
    click to search medicines.org.uk
    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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