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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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02.04  Expand sub section  Beta-adrenoceptor blocking drugs
Atenolol
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Formulary
Green
Tablet, Liquid, (Injection - secondary care only)
 
Link  SFH guide: IV atenolol for perioperative betablocker replacement
   
Bisoprolol
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Formulary
Green

Tablet

  • First line use for heart failure
  • Tablets disperse in water if needed, click here for more information. See here for general advice on dispersing tablets.
 
   
Carvedilol
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Formulary
Green
Tablet
Second line use for heart failure 
   
Esmolol
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Formulary
Red

Injection (secondary care only)

  • Current supply problem with no date available for resupply. (Jan 2020)
 
Link  SFH esmolol infusion information
   
Labetalol
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Formulary
Green

Tablet, (Injection - secondary care only)

  • Tablets disperse in water if needed but administer immediately as the drug is sensitive to oxidisation. See here for general advice on dispersing tablets.
 
Link  SFH: Labetalol infusion guidance
Link  SFH: Labetalol- Prescription and Administration Record for Labetalol IV Infusion (Acute stroke)
   
Metoprolol
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Formulary
Green
Tablet, (Injection - secondary care only)
(Tablet MR is non formulary)
  • Heart failure- third line, where there is a perceived need to use a short acting cardioselective beta-blocker. Consideration should be given to switching to a once daily beta blocker once patient is stable
  • Tablets disperse in water if needed. Do not crush or disperse MR tablets. See here for general advice on dispersing tablets. 
  •    
    Nadolol
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    Formulary
    Amber 2
    Tablet
  • For patients with Long QT syndrome. Use in other indications is classified grey (APC Nov 14).
  • The only beta blocker suitable for some patients in long QT syndrome. 
  • Link  Link to reviews
       
    Propranolol
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    Formulary
    Green

    Tablet, Capsule MR, Oral solution, (Injection - secondary care only)

    • If needed MR capsules can be opened and beads mixed with water - do not crush. (Personal communication with manufacturer, 2009) More Info
    • Locally recommended strength for oral solution is 50mg/5mL.
     
       
    Sotalol
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    Formulary
    Amber 2
    Tablet
  • Sotalol should not be used as a beta blocker purely for rate control of AF, but is a useful class 3 antiarrhythmic for a rhythm control strategy.
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets. 
  •    
    Timolol
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    Formulary
    Amber 2
    Tablet
  • For post MI use
  • Tablets disperse in water if needed immediately before administration. See here for general advice on dispersing tablets. 
  • Link  Link to reviews
       
     ....
     Non Formulary Items
    Acebutolol  (Sectral®)

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    Non Formulary
    Grey
     
    Atenolol and Co-amilozide  (Kalten)

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    Non Formulary
    Grey
     
    Atenolol and Nifedipine  (Beta-Adalat)

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    Non Formulary
    Grey
     
    Atenolol and Nifedipine  (Tenif)

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    Non Formulary
    Grey
     
    Burinex A

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    Non Formulary
    Grey
     
    Celiprolol

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    Non Formulary
    Grey
     
    Co-amilozide

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    Non Formulary
    Grey
    amiloride/ hydrochlorothiazide
     
    Co-flumactone

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    Non Formulary
    Grey
     
    Co-tenidone (atenolol and chlortalidone)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Co-triamterzide

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    Non Formulary
    Grey
     
    Dyazide

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    Non Formulary
    Grey
     
    Frusene

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    Non Formulary
    Grey
     
    Kalspare

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    Non Formulary
    Grey
     
    Lasilactone

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    Non Formulary
    Grey
     
    Navispare

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    Non Formulary
    Grey
     
    Nebivolol  (Nebilet)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Classified grey for essential hypertension
    Link  Link to reviews
     
    Oxprenolol

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    Non Formulary
    Grey
     
    Oxprenolol and Cyclopenthiazide  (Trasidrex)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Pindolol  (Visken®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Pindolol and Clopamide  (Viskaldix)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Timolol and Bendroflumethiazide  (Prestim)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Timolol and Co-amilozide  (Moducren)

    View adult BNF View SPC online View childrens BNF
    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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