netFormulary South East London Joint Medicines Formulary NHS
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
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02.12  Expand sub section  Lipid-regulating drugs
Alirocumab injection

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Restricted Drug Restricted
High Cost Medicine
Red
Specialist initiation only
Restricted to use as per stipulations in NICE guidance (see below)

Link  NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia    
Evolocumab injection

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Restricted Drug Restricted
High Cost Medicine
Red
Specialist initiation only
Restricted to use as per stipulations in NICE guidance (see below)

Link  NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia    
02.12  Expand sub section  Bile acid sequestrants
Colesevelam tabs

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Restricted Drug Restricted CONSULTANT LIPIDOLOGISTS ONLY
  • Fifth-line monotherapy after statins, fibrates, niacin and ezetimibe for patients intolerant of other lipid-lowering drugs
  • Add-on therapy for patients on multiple lipid lowering drugs not achieving LDL-C and total cholesterol serum targets currently defined by the National Service Framework for Cornonary Heart Disease
  •    
    Colestyramine sachets

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    Formulary
       
    02.12  Expand sub section  Ezetimibe
    Ezetimibe tabs

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    Formulary

    Link  NICE TA385:Ezetimibe for primary heterozygous-familial and non-familial hypercholesterolaemia    
    02.12  Expand sub section  Fibrates
    Bezafibrate tabs, m/r tabs

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    Formulary
       
    Fenofibrate tabs

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    Formulary
       
    Ciprofibrate tabs

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    Formulary
       
    Gemifibrozil tabs

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    Formulary
       
    02.12  Expand sub section  Statins to top
    Atorvastatin tabs

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    First Choice
    Pravastatin tabs

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    Formulary
       
    Rosuvastatin tabs

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    Restricted Drug Restricted Initiation on the recommendation of a Consultant in the Lipid Clinic, Diabetes Unit, HIV Unit or Cardiology only

    Restricted to use for:

  • Familial hyperlipidaemia (FH), where other statins have failed to achieve a >50% fall in LDL cholesterol. These patients should be under the care of a lipid clinic

  • Second line for patients requiring ‘high intensity statin’ post ACS, with contraindications or drug interactions that prevent the use of high doses of atorvastatin

  • Third line for patients with CVD or diabetes requiring substantial falls in cholesterol to achieve the minimum QoF audit standard (total cholesterol <5mmol/L and LDL <3mmol/L) with previous failure to tolerate up titrated doses of / or max doses of atorvatatin, and where
    pravastatin is unlikely to deliver the lipid lowering potency required to reach these target levels
  •    
    Simvastatin tabs

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    Formulary
       
    02.12  Expand sub section  Nicotinic acid group
    Nicotinic acid tabs, m/r tabs caps

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    Restricted Drug Unlicensed
    Amber 2
    INITIATION BY CONSULTANT SPECIALISTS ONLY
    Note: currently there are no licensed preparations available in the UK
       
    02.12  Expand sub section  Omega-3 fatty acid compounds
    Omega-3-Acid Ethyl Esters capsules

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    Restricted Drug Restricted
    Amber 1
    Adjunctive therapy in the reduction of plasma triglycerides in patients with hypertriglyceri-daemia at risk of ischaemic heart disease or pancreatitis
    See APC guidance for the management of hypertriglyceridaemia (above)
       
    Omega-3-Marine Triglycerides capsules

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    Restricted Drug Restricted
    Amber 1
    Adjunctive therapy in the reduction of plasma triglycerides in patients with hypertriglyceri-daemia at risk of ischaemic heart disease or pancreatitis
       
    02.12  Expand sub section  PCSK9 inhibitors
    02.12  Expand sub section  Other lipid modifying agents
     ....
    Key
    note Notes First Choice Item First Choice item
    Section Title Section Title (top level) Non Formulary Item Non Formulary section
    Section Title Section Title (sub level)
    Cytotoxic Drug
    Cytotoxic Drug
    Restricted Drug
    Restricted Drug
    CD
    Controlled Drug
    Unlicensed Drug
    Unlicensed
    High Cost Medicine
    High Cost Medicine
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    Link to SPCs
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    Link to adult BNF
    Track Changes
    Display tracking information
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    Cancer Drugs Fund
    Cancer Drugs Fund
       

     

    Traffic Light Status Information

    Status Description
      Red   Specialist Prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist. 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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