| Formulary Chapter 2: Cardiovascular system - Full Chapter
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| 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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| Chapter Links... |
 NICE NG106: Chronic heart failure in adults: diagnosis and management |
 SE London APC guidance: optimising therapy in chronic stable angina |
| SE London APC Guidance: Pharmacological management of Heart Failure |
| SE London Area Prescribing Committee: General Principles of Heart Failure Management During COVID-19 |
| Details... |
| 02.12 |
Lipid-regulating drugs |
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Alirocumab injection
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 Restricted
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 Specialist initiation only
Approved as per NICE technology appraisal guidance (see links 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
Approved as per NICE technology appraisal guidance (see links below)
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NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
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Volanesorsen injection
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Restricted
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Specialist initiation only
Approved for use in accordance with NICE Highly specialised technologies guidance (see link below)
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NICE HST13: Volanesorsen for treating familial chylomicronaemia syndrome
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| 02.12 |
Bile acid sequestrants |
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Colesevelam tabs (hypercholesterolaemia)
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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 (hypercholesterolaemia)
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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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Approved as per NICE technology appraisal guidance (see links below)
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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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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
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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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| Non Formulary Items |
Omega-3-Acid Ethyl Esters capsules
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Non Formulary
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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) |
Omega-3 fatty acid and other fish oil supplements review – prescribing fact sheet
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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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