| Formulary Chapter 2: Cardiovascular system - Full Chapter
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| Chapter Links... |
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 SE London APC guidance: optimising therapy in chronic stable angina |
| SE London APC Guidance: Pharmacological management of Heart Failure |
| Details... |
| 02.12 |
Lipid-regulating drugs |
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Alirocumab injection
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 Restricted
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 Specialist initiation only
Restricted to use as per stipulations in NICE guidance (see below)
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NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
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Evolocumab injection
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Restricted
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Specialist initiation only
Restricted to use as per stipulations in NICE guidance (see below)
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NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
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| 02.12 |
Bile acid sequestrants |
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Colesevelam tabs
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Restricted
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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
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Colestyramine sachets
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Formulary
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| 02.12 |
Ezetimibe |
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Ezetimibe tabs
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Formulary
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NICE TA385:Ezetimibe for primary heterozygous-familial and non-familial hypercholesterolaemia
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| 02.12 |
Fibrates |
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Bezafibrate tabs, m/r tabs
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Formulary
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Fenofibrate tabs
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Formulary
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Ciprofibrate tabs
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Formulary
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Gemifibrozil tabs
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Formulary
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| 02.12 |
Statins |
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Atorvastatin tabs
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First Choice
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Pravastatin tabs
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Formulary
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Rosuvastatin tabs
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Restricted
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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
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Simvastatin tabs
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Formulary
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| 02.12 |
Nicotinic acid group |
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Nicotinic acid tabs, m/r tabs caps
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 Unlicensed
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INITIATION BY CONSULTANT SPECIALISTS ONLY
Note: currently there are no licensed preparations available in the UK
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| 02.12 |
Omega-3 fatty acid compounds |
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Omega-3-Acid Ethyl Esters capsules
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Restricted
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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)
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Omega-3-Marine Triglycerides capsules
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Restricted
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Adjunctive therapy in the reduction of plasma triglycerides in patients with hypertriglyceri-daemia at risk of ischaemic heart disease or pancreatitis
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| 02.12 |
PCSK9 inhibitors |
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| 02.12 |
Other lipid modifying agents |
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Description |
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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.
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Treatment can be initiated in primary care after a recommendation from an appropriate specialist |
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Specialist initiation followed by maintenance prescribing in primary care |
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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 |
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Specialist and non-specialist initiation |
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Not recommended for prescribing |
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