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
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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02.12  Expand sub section  Lipid-regulating drugs
Alirocumab injection
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Restricted Drug Restricted
Red
High Cost Medicine

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
Red
High Cost Medicine

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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    Unlicensed 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 2

    New patients should only be initiated omega-3 fatty acids by a lipid specialists. The place of omega 3 fatty acids supplements in hypertriglyceridemia is clearly defined in the SE London APC guidance: Management of hypertriglyceridaemia

     

     
       
    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
     ....
     Non Formulary Items
    Omega-3-Acid Ethyl Esters capsules

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    Non Formulary
    Grey

    NHS England considers omega-3 fatty acid supplements as an item which should not be routinely prescribed in primary care and will monitor the prescribing of omega-3 fatty acid supplements. Refer to the prescribing factsheet for more information (link below)

    Link  Omega-3 fatty acid and other fish oil supplements review – prescribing fact sheet
     
      
    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
    click to search medicines.org.uk
    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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