| Formulary Chapter 2: Cardiovascular system - Full Chapter
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| 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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| Chapter Links... |
 NICE NG106: Chronic heart failure in adults: diagnosis and management |
 SE London APC guidance: optimising therapy in chronic stable angina |
| SE London APC Guidance: Pharmacological management of Heart Failure |
| SE London Area Prescribing Committee: General Principles of Heart Failure Management During COVID-19 |
| Details... |
| 02.06.02 |
Calcium-channel blockers |
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For the use of calcium-channel blockers in the management of stable angina, please refer to NICE clinical guideline 126. Calciumchannel blockers and beta-blockers should be considered as first line treatment options for stable angina.
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Amlodipine tabs
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First Choice
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 First-line dihydropyridine calcium channel blocker
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Nifedipine caps, m/r tabs, m/r caps
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Formulary
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Diltiazem tabs, m/r tabs, m/r caps
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Formulary
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Verapamil tabs, m/r tabs (licensed use)
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Formulary
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Nimodipine tabs, injection
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Formulary
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Felodipine m/r tabs
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Formulary
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 Second line dihydropyridine calcium channel blocker at LGT (after amlodipine)
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Lacidipine tabs
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Formulary
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Nicardipine injection
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 Restricted
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Second line option for severe hypertension (after labetalol) in critical care settings only
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Nicardipine tabs
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Formulary
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Verapamil injection (radial access procedures - off-label)
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Formulary
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Approved off-label indication:
- Intra-radial artery injection to prevent radial artery spasm in radial access procedures
Dose = 2.5 mg. Isosorbide dinitrate 400 micrograms given in conjunction for this indication.
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Flunarizine caps, tabs
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 Unlicensed
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 Approved for:
- Intermittent claudication
- Raynaud’s syndrome
- Prophylaxis of migraine
- Vertigo
Protocol for prophyaxis of migraine:
- Starting dose of 10 mg at night (5mg for patients ≥65 years). Treatment should be discontinued if no significant improvement observed after 2 months.
- Maintenance treatment should continue at the same daily dose but interrupted by two successive drug-free days every week, e.g. Saturday and Sunday.
- All patients should have treatment stopped after 6 months and it should only be re-initiated if the patient relapses.
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Description |
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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.
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Treatment can be initiated in primary care after a recommendation from an appropriate specialist |
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Specialist initiation followed by maintenance prescribing in primary care |
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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 |
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Specialist and non-specialist initiation |
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Not recommended for prescribing |
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