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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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02.05.01  Expand sub section  Vasodilator antihypertensive drugs
Bosentan
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Formulary
Red
High Cost Medicine
  • Medicines for pulmonary hypertension are commissioned via specialist centres only, see the policy below.
  • Contact High Cost Drugs pharmacists or Medicines Information for further info.
  • Nottingham NHS Treatment Centre: for the treatment of digital ulceration in systemic sclerosis as per commissioning policy.
  • Risk Minimisation Materials are available for bosentan (available from the eMC)
 
Link  NHSE Clinical Commissioning Policy: Treatment of Digital Ulceration in Systemic Sclerosis
Link  NHSE: National Pulmonary Hypertension commissioning policy
   
Hydralazine
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Formulary
Green
Tablet
  • May be used in combination with a nitrate in the management of heart failure in patients who are intolerant of ACE inhibitors.
  • Tablets disperse in water if needed but this may increase the rate of absorption. See here for general advice on dispersing tablets. Tablets are sugar coated and are likely to block enteral feeding tubes. Blood pressure monitoring recommended.  
  •    
    Iloprost injection
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    Formulary
    Red
    High Cost Medicine

    Injection

    • Restricted for peripheral vascular and rheumatology use (prescribing out of hours should be avoided for rheumatology indications at NUH).
     
    Link  SFH: Iloprost guidelines for Raynaud’s (links to everything needed)
    Link  Commissioning Policy - Pulmonary hypertension in adults
    Link  Link to reviews
       
    Iloprost nebules (Vantavis®)
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    Formulary
    Red
    Nebule
  • Restricted for NUH use in pulmonary hypertension on advice of tertiary centre 
  • Link  Link to reviews
       
    Minoxidil
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    Formulary
    Amber 2

    Tablets

    • May be used in severe hypertension where other medication is unable to achieve control.
    • Should not be used as monotherapy but in conjunction with a diuretic and beta-blocker.
     
       
    Sildenafil
    (digital ulcers)
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    Formulary
    Amber 2
    • For Systemic Sclerosis patients with digital ulcers as advised by NHS E policy.
    • Initiated at treatment centre. 6 weeks provided, to be passed to primary care after review at this point.
     
    Link  NHSE Clinical Commissioning Policy: Treatment of Digital Ulceration in Systemic Sclerosis
    Link  NICE Evidence summary: Sildenafil for digital ulcers
       
    Sildenafil (Revatio®)
    (pulmonary hypertension)
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    Formulary
    Red
    High Cost Medicine
  • Medicines for pulmonary hypertension are commissioned via specialist centres only.
  • Contact High Cost Drugs pharmacists or Medicines Information for further info
  • At SFH for Commissioning detail see Information sheet here
  • Licensed liquid available for use in paediatric intensive care at NUH in line with local guidance
  •  
    Link  NHSE: National Pulmonary Hypertension commissioning policy
    Link  NICE ESUOM51: Pulmonary hypertension in neonates
       
    Sodium nitroprusside
    Formulary
    Red
    Injection (secondary care only)
  • Unlicensed supply available through importing companies
     
  •    
    Tolazoline
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    Formulary
    Red
    Injection
  • Named patient use
  • Restricted for neonatal use only 
  •    
     ....
     Non Formulary Items
    Ambrisentan

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    Non Formulary
    Grey
    High Cost Medicine

    Medicines for pulmonary hypertension are commissioned via specialist centres only.

    • Contact High Cost Drugs pharmacists or Medicines Information for further info
    Link  Link to reviews
    Link  NHSE: National Pulmonary Hypertension commissioning policy
     
    Macitentan  (Opsumit®
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    Non Formulary
    Grey
    High Cost Medicine

    Medicines for pulmonary hypertension are commissioned via specialist centres only.

    Link  Link to reviews
     
    Riociguat  (Adempas®)

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    Non Formulary
    Grey
    High Cost Medicine
    Medicines for pulmonary hypertension are commissioned via specialist centres only.
  • Contact High Cost Drugs pharmacists or Medicines Information for further info
  • Grey non-formulary (no formal assessment) - awaiting National Commissioning policy (APC May 2014 horizon-scanning)
  • Link  Link to reviews
     
    Sitaxentan Sodium  (Thelin®)

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    Non Formulary
    Grey
    Withdrawn 2010
     
    Tadalafil  (Adcirca®)
    (Pulmonary hypertension)

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    Non Formulary
    Grey
    Medicines for pulmonary hypertension are commissioned via specialist centres only.
  • Contact High Cost Drugs pharmacists or Medicines Information for further info
  • At SFH for Commissioning detail see Information sheet here
  • Link  National Pulmonary Hypertension commissioning policy
     
      
    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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