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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
02.08.01  Expand sub section  Heparin
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
    02.08.01  Expand sub section  Hirudins to top
    02.08.01  Expand sub section  Heparin flushes
    02.08.01  Expand sub section  Epoprostenol
    02.08.01  Expand sub section  Fondaparinux
     ....
     Non Formulary Items
    Bemiparin

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    Non Formulary
    Grey
     
    Enoxaparin  (BECAT® )

    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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