Where treatment is imperative and oral treatment is not possible (including indications for which tablets are licensed but use of suppositories would be off-label e.g. TIA)
Cangrelor injection
Restricted
Approved for use (in combination with aspirin suppositories) for the reduction of thrombotic cardiovascular events in patients with coronary artery disease undergoing PCI.
Restricted to unconscious patients in whom oral therapy with P2Y12 inhibitors (e.g. clopidogrel) is not feasible.
Clopidogrel tabs
Formulary
Use as per NICE CG94: ACS and NSTEMI (see link below at end of section)
Use as per NICE TA210: Prevention of occlusive vascular events (see link below at end of section)
Dipyridamole tabs, m/r caps, oral suspension
Formulary
Use as per NICE TA210: Prevention of occlusive vascular events (see link below at end of section)
Eptifibatide injection (endovascular management of intracranial aneurysms - off-label)
Formulary
Approved off-label indication:
Thromboembolic complications during endovascular management of intracranial aneurysms
Refer to local approved guideline at KCH
Eptifibatide injection (licensed use)
Formulary
USE UNDER SPECIALIST SUPERVISION ONLY
Use as per NICE CG94: ACS and NSTEMI (see link below at end of section)
Prasugrel tabs
Formulary
Approved as per NICE technology appraisal guidance (see links below)
Use as per NICE CG94: ACS and NSTEMI (see link below at end of section) Use for reduction of cardiovascular events in patients with STEMI intended for primary PCI
Refer to local guidelines for use
Aspirin injection (endovascular management of intracranial aneurysms)
Unlicensed
Approved off-label indication:
Thromboembolic complications during endovascular management of intracranial aneurysms
Refer to local approved guideline at KCH
Ticlopidine tabs
Unlicensed
Intolerance to aspirin or clopidogrel. Dose: 250 mg bd
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
USE UNDER SPECIALIST SUPERVISION ONLY
Restricted
Approved for use (in combination with aspirin suppositories) for the reduction of thrombotic cardiovascular events in patients with coronary artery disease undergoing PCI.
Approved off-label indication:
Unlicensed
