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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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02.08.01  Expand sub section  Parenteral anticoagulants
Argatroban (Exembol®)
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Restricted Drug Restricted
Red

Infusion

  • NUH only See guideline
 
Link  Link to reviews
Link  NUH: Treatment of heparin induced thrombocytopenia (HIT) in Adults
   
02.08.01  Expand sub section  Heparin
Heparin
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Formulary
Red
Heparin sodium 1000 units in 1mL (20ml amps no longer available)
NUH only:
Heparin sodium mucous 1000 units in 1ml (5mL vial) for renal dialysis patients
Heparin sodium 1000 units in 1ml (5mL ampoule) preservative free for X-ray only
Heparin sodium mucous 5000 units in 1ml for renal dialysis patients
Heparin sodium 25000 units in 5mL vial with preservative for renal dialysis patients
Heparin calcium injection - prefilled syringes
 
Link  SFH Unfractionated Heparin Schedules and Guidelines
   
02.08.01  Expand sub section  Low molecular weight heparins
Enoxaparin (Inhixa® or Clexane®)
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First Choice
Amber 2

Injection

  • Two brands now available: Inhixa® and Clexane®.
    - Inhixa is the preferred brand in Nottinghamshire, but Clexane is still available in primary care for existing patients.
    - Enoxaparin should be BRAND PRESCRIBED and patients should be maintained on the same brand where possible. If a need to switch arises (eg during supply problems), appropriate patient counselling should occur as there are device differences.
  • Used for prophylactic use and treatment of DVT and PE.
  • For unstable angina - see fondaparinux.
  • SFH: Dosing table and links to guidelines
  • NUH: Dosing guidelines
 
Dalteparin
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Restricted Drug Restricted
Amber 2
Injection
  • Restricted use at NUH only.
  • Glass ampoules for latex allergy patients
  • For prophylactic use and treatment of DVT and PE
     
  • Link  Link to reviews
       
    Tinzaparin
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    Restricted Drug Restricted
    Red

    Injection

    • Restricted for prophylaxis against VTE in haemodialysis patients.
     
    Link  Renal unit tinzaparin algorithm 1
    Link  Renal unit tinzaparin algorithm 2
    Link  Renal unit tinzaparin algorithm 3
    Link  Renal unit tinzaparin administration record
       
    02.08.01  Expand sub section  Heparinoids
    Danaparoid (Orgaran®)
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    Restricted Drug Restricted
    Red
    Injection (secondary care only)
    Specialist use only for HITT
     
    Link  NUH: Anticoagulation in HIT or heparin allergy / danaparoid guidance - (NUH Guideline In Development-June 2014)
    Link  SFH danaparoid prescribing guideline
       
    02.08.01  Expand sub section  Hirudins to top
    Bivalirudin (Angiox®)
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    Formulary
    Red
    Injection (secondary care only)
    SFH only for anticoagulation during PCI as an alternative to abciximab and heparin
    NUH: Restricted to use in accordance with NICE TAG 230 and CG94. Consultant recommendation only. 
    Link  Bivalirudin PCI dosing table
    Link  Cost comparison of bivalirudin vs abciximab
    Link  Link to reviews
    Link  MHRA Drug Safety Update: Risks associated with incorrect dose
    Link  NICE CG 94:Unstable angina and NSTEMI
    Link  NICE TAG 230 : Bivalirudin for the treatment of STEMI, 2011
       
    02.08.01  Expand sub section  Heparin flushes
    Heparin
    (Flush)
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    Restricted Drug Restricted
    Amber 2
    Available as:
    - 1 unit in 1mL (500mL sodium chloride 0.9%)
    - 10 units in 1mL (5mL ampoule)-prev known as Hepsal
    - 100 units in 1mL (2mL ampoule)-prev known as Canusal
    - 100 units in 1mL (500mL sodium chloride 0.9%)
  • Shouldn't be used for flushing peripheral cannulas- use 0.9% sodium chloride instead. 
  • Link  Notts Children’s Hospital: CF Management Guideline (see pages 21/22 for heparin flushes)
    Link  SFH guide to central lines and heparin flushes
    Link  UKMI Q&A: Heparin vs saline flushes for maintenance of patency in intravascular catheters & cannulae
       
    02.08.01  Expand sub section  Epoprostenol
    Epoprostenol (Flolan®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Infusion (secondary care only)
  • At SFH restricted to ICCU haemofiltration patients only.
  • Product has been reformulated. Carefully read reconstitution and administration instructions. 
  • Link  MHRA: incompatibilities between Veletri and some administration devices
    Link  NHSE policy for the treatment of pulmonary hypertension
       
    02.08.01  Expand sub section  Fondaparinux
    Fondaparinux (Arixtra®)
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    Formulary
    Red
    Injection
  • For patients with ACS/NSTEMI in line with guidelines below.
  • For use within its licensed indication for patients intolerant of heparin or heparinoids (due to HITT or allergy) or where it is inappropriate due to patient beliefs. 
  • Link  Link to reviews
    Link  Fondaparinux guideline for the management of acute coronary syndromes – NUH 2016
    Link  SFH only: Fondaparinux guidelines for ACS/NSTEMI
       
     ....
     Non Formulary Items
    Bemiparin

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    Non Formulary
    Grey
     
    Enoxaparin  (BECAT® )

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    Non Formulary
    Grey
     
    Lepirudin

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    Non Formulary
    Grey
    Injection
  • Previously available at SFH during danaparoid supply problems.
  • Was discontinued April 2012
  •  
      
    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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