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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.

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02.10.02  Expand sub section  Fibrinolytic drugs
Urokinase injection
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Formulary
Red

Occluded intravenous catheters and cannulas blocked by fibrin clots

Dose: 10 000 units in 2-3 mL of sodium chloride 0.9%. Should be retained in the line for 2-4 hours before aspirating

 
   
Alteplase 2 mg injection (Actilyse Cathflo)
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Formulary
Red

Approved for use in for malfunctioning tunnelled Central Venous Haemodialysis Catheters (CVHC)

Follow local guideline for use at GSTT amd KCH

 
   
Alteplase injection (catheter directed thrombolysis in DVT - off-label)
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Formulary
Red

Approved off-label indication:

Catheter directed thrombolysis in acute subclavian and/or iliofemoral deep vein thrombosis (DVT)

Follow the "Acute Deep Vein Thrombosis Catheter Directed Thrombolysis Protocol" on GTi for dosing and administration

 
   
Alteplase injection (licensed use in massive PE and stroke)
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Formulary
Red

USE UNDER SPECIALIST SUPERVISION ONLY

For use in ischaemic stroke as per NICE TA264 Acute massive pulmonary embolism: Refer to local guidelines

 
Link  NICE TA264: Ischaemic stroke (acute) - alteplase
   
Alteplase injection (Off-label use in intrapleural fibrinolysis)
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Formulary
Red

Approved off-label indication:

  • Intrapleural fibrinolysis for complex pleural infection (together with dornase alpha)
  • UNDER SPECIALIST SUPERVISION ONLY
  • Follow local guidelines at GSTT
  • Regimen: Alteplase 10mg in 50ml sodium chloride 0.9% administered intrapleurally Dornase 5mg in sodium chloride 0.9% administered intrapleurally separately
  • Dose: Every 12 hours for a maximum of 3 days
 
   
Dornase alpha nebuliser liquid (Off-label use in intrapleural fibrinolysis)
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Formulary
Red

Approved off-label indication:

  • Intrapleural fibrinolysis for complex pleural infection (together with alteplase)

UNDER SPECIALIST SUPERVISION ONLY Follow local guidelines at GSTT

Regimen: Dornase 5mg in 50ml sodium chloride 0.9% administered intrapleurally

Alteplase 10mg in sodium chloride 0.9% administered intrapleurally separately

Dose: Every 12 hours for a maximum of 3 days

 
   
Streptokinase injection
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Formulary
Red
 
   
Streptokinase injection
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Formulary
Red

Approved off-label indication:

Treatment of airway thrombus in patients receiving ECMO

CONSULTANT ICU SPECIALIST ONLY

 
   
Tenecteplase injection
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Formulary
Red
 
   
Urokinase injection
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Formulary
Red

Approved off-label indication:

Intrapleural use for treatment of loculated malignant pleural effusions.

Dose: 100,000 units every 12 hours for 3 doses only

CONSULTANT RESPIRATORY PHYSICIAN PRESCRIBING AND ADMINISTRATION ONLY

 
   
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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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