South East London Joint Medicines Formulary Formulary

	South East London Joint Medicines Formulary
	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

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.

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

Details...

02.06.02

Calcium-channel blockers

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.

Amlodipine tabs

First Choice

First-line dihydropyridine calcium channel blocker

Nifedipine caps, m/r tabs, m/r caps

Formulary

Diltiazem tabs, m/r tabs, m/r caps

Formulary

Verapamil tabs, m/r tabs

Formulary

Nimodipine tabs, injection

Formulary

Felodipine m/r tabs

Formulary

Second line dihydropyridine calcium channel blocker at LGT (after amlodipine)

Lacidipine tabs

Formulary

Nicardipine injection

Restricted

Second line option for severe hypertension (after labetalol) in critical care settings only

Nicardipine tabs

Formulary

Flunarizine caps, tabs

Unlicensed

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.

NICE CG126: Stable angina: management

NICE CG127: Hypertension in adults: diagnosis and management

SE London APC Guidance: Managing uncomplicated hypertension

SE London APC Traffic light Guide to BP Measurement

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Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	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.
	Treatment can be initiated in primary care after a recommendation from an appropriate specialist
	Specialist initiation followed by maintenance prescribing in primary care
	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
	Specialist and non-specialist initiation
	Not recommended for prescribing