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Nottinghamshire Area Prescribing Committee
Joint Formulary
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.02.03  Expand sub section  Potassium-sparing diuretics and aldosterone antagonists
Amiloride Hydrochloride
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Formulary
Green

Tablet, Oral solution (5mg/5ml)

  • Licensed oral solution available (approx £37 per 28 days vs £1.25 for tabs).
  • Tablets disperse in water if necessary (not licensed). See here for general advice on dispersing tablets.
 
   
02.02.03  Expand sub section  Aldosterone antagonists
Spironolactone
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First Choice

Green- Tablet

  • Low dose (25mg daily) in addition to an ACE inhibitor for severe heart failure (£2 per month)
  • Monitor renal function and electrolytes. See Nottinghamshire heart failure lights
    for monitoring requirements
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • Amber2 Amber2 - Unlicensed liquid medicine available for paediatrics:
    10mg in 5mL (at SFH)
    25mg in 5mL
     (at NUH) - For paediatric patients, it is recommended to use a product which does not contain propylene glycol (e.g. from NUH NSM)
  • Grey for polycystic ovary syndrome related hirsutism
 
Eplerenone
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Restricted Drug Restricted
Amber 2
Tablet
  • Second line agent if spironolactone is not tolerated for use within the licensed indication of stable post MI patients with left ventricular dysfunction and clinical evidence of heart failure in line with NICE guidance. Classified Amber 2.
  • Second line aldosterone antagonist if spironolactone is not tolerated for NYHA class II heart failure. Classified amber 2.
  • See Nottinghamshire heart failure lights for more information on hyperkalaemia and dosing.
  • Tablets may be crushed and dispersed in water or mixed in apple sauce. See here for general advice on dispersing tablets.
     
  • Link  Independent reviews
    Link  NICE NG106: Chronic heart failure
       
     ....
     Non Formulary Items
    Triamterene  (Dytac®)

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    Non Formulary
    Grey
     
      
    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 children's 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

    Grey

    Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.
    Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting.
    Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
      

    Red

    Medicines which should normally be prescribed by specialists only. eg hospital only.
    For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
      

    Amber 1

    Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
    Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.
      

    Amber 2

    Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
    A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
    *Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
      

    Amber 3

    Primary care/ non specialist may initiate as per APC guideline.
    The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
      

    Green

    Medicines suitable for routine use within primary care.
    Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.   

    OTC

      

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