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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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02.08.02  Expand sub section  Oral anticoagulants
Warfarin
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Formulary
Green

Available as:
- Only 3mg tablets are routinely used in Nottinghamshire
- Suspension 1mg/ml, £101 per 150ml, 28 day expiry
- 1mg tablet - Restricted for anticoagulant clinic request only and for prophylaxis in oncology patient with indwelling catheter.

  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
 
Link  NUH warfarin dosing protocols
Link  SFH warfarin dosing protocol
Link  Anticoagulation in AF guideline (NottsAPC)
Link  COVID19: Can we extend the INR testing interval? (Notts CCG)
Link  COVID19: Should I switch warfarin to a DOAC? (Notts CCG)
Link  NPSA warfarin booklet
Link  NUH Lite Bite: Co-prescribing of anticoagulant and antiplatelet drugs (Oct 18)
Link  Oral anticoagulant therapy patient booklets in different languages
Link  SFH patient counselling guidelines
Link  UKMI Q&A: IM injections in warfarin patients
Link  UKMI Q&A: Warfarin and PPI interaction
   
Edoxaban (Lixiana)
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Formulary
Amber 3

Treatment of DVT or PE and prevention of recurrent DVT or PE:
 - Specialist initiation in line with NICE TA354. For advice regarding switching between anticoagulants check the local prescribing information and the SPC.

Stroke prevention in AF:
 For use in line with Atrial Fibrillation (AF) anticoagulation guideline. Edoxaban is the first line DOAC for patients with NVAF unless there is a specific clinical reason to use a different DOAC - see Notts APC DOAC position statement.

 
Link  Anticoagulant dosing links & information (DOACs & Enoxaparin)
Link  COVID19: Can the DOAC monitoring interval be extended? (Notts CCG)
Link  Edoxaban dose compilation table (SFH)
Link  NICE TA355:Edoxaban for preventing stroke/systemic embolism in non‑valvular AF
Link  Nottinghamshire DOAC alert card
Link  NUH Lite Bite: Co-prescribing of anticoagulant and antiplatelet drugs (Oct 18)
Link  NUH: Counselling of patients starting DOACs (pharmacy procedure)
Link  NUH: Haemorrhage or Emergency Surgery guideline for apixaban/edoxaban/rivaroxaban patients
Link  Risk minimisation resources
   
Apixaban (Eliquis)
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Formulary
Amber 3

Stroke prevention in non-valvular AF:
For use in line with Atrial Fibrillation (AF) anticoagulation guideline. Note that Edoxaban is the first line DOAC for patients with NVAF unless there is a specific clinical reason to use a different DOAC - see Notts APC DOAC position statement.


Treatment of DVT or PE and prevention of recurrent DVT or PE:
 As an option per NICE TA341. See Prescribing Information

 
Link  Anticoagulant dosing links & information (DOACs & Enoxaparin)
Link  Apixaban dosing table (SFH)
Link  Atrial Fibrillation (AF) anticoagulation guideline (NottsAPC)
Link  COVID19: Can the DOAC monitoring interval be extended? (Notts CCG)
Link  Link to reviews
Link  Manufacturers Patient Alert Card
Link  MHRA: Risk of Haemorrhage - clarification on contraindications, 2013
Link  NICE TA275: Apixaban for AF
Link  Nottinghamshire DOAC alert card
Link  NUH Lite Bite: Co-prescribing of anticoagulant and antiplatelet drugs (Oct 18)
Link  NUH: Counselling of patients starting DOACs (pharmacy procedure)
Link  NUH: Haemorrhage or Emergency Surgery guideline for apixaban/edoxaban/rivaroxaban patients
   
Dabigatran (Pradaxa)
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Formulary
Amber 3

Capsules
Stroke prevention in non valvular AF:
-As per Atrial Fibrillation (Non-valvular) - anticoagulation choice

  • Do not crush or open capsules as this increases bioavailability by 75%.
  • Note that Edoxaban is the first line DOAC for patients with NVAF unless there is a specific clinical reason to use a different DOAC - see Notts APC DOAC position statement.

Treatment of DVT or PE and prevention of recurrent DVT or PE:
 -Specialist initiation in line with NICE TA327

  • See Prescribing Information
  • For advice regarding switching between anticoagulants check the local guidelines and the SPC.
 
Link  COVID19: Can the DOAC monitoring interval be extended? (Notts CCG)
Link  Link to reviews
Link  MHRA: prosthetic heart valves contraindication alert, 2013
Link  MHRA: Renal function information
Link  MHRA: Risk of haemorrhage - clarification on contraindications, 2013
Link  NICE TA249: Dabigatran for Stroke prevention in AF
Link  NUH Lite Bite: Co-prescribing of anticoagulant and antiplatelet drugs (Oct 18)
Link  NUH: Counselling of patients starting DOACs (pharmacy procedure)
Link  NUH: Haemorrhage or Emergency Surgery guideline for dabigatran
Link  Manufacturers DOAC alert card (Dabigatran only)
   
Rivaroxaban (Xarelto)
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Formulary

Stroke prevention in AF:
For use in line with Atrial Fibrillation (AF) anticoagulation guideline. Note that Edoxaban is the first line DOAC for patients with NVAF unless there is a specific clinical reason to use a different DOAC - see Notts APC DOAC position statement.

Treatment of DVT or PE and prevention of recurrent DVT or PE: Tablets 10mg, 15mg & 20mg
 - GPs may continue after specialist initiation in line with NICE. See Prescribing Information

Treatment of ACS:
- Cardiology specialist recommendation only. An option as per NICE TA. Course length to be specified by specialist and regular review advised. N.B. lower dose and different frequency of administration compared to other indication. Care as dose corresponds to therapeutic dosing of apixaban

Prevention of thrombotic events in CAD or PAD.
- As per NICE TA607
Prevention of CVD in AF patients undergoing cardioversion
-Non-formulary (no formal assessment)
Prophylaxis of VTE post hip and knee replacement surgery:
Complete course will be supplied by hospital.

  • Rivaroxaban PILs for AF, DVT & PE
  • NICE Guidelines for AF, DVT, PE & ACS
  • Approved for use at SFH only in line with trust thromboprophylaxis guidelines.
  • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
  • 15mg and 20mg tablets should be taken with or after food.
  • 2.5mg and 10mg tablets can be taken with or without food.
 
Link  Link to reviews
Link  MHRA: Risk of haemorrhage - clarification on contraindications (2013)
Link  Anticoagulant dosing links & information (DOACs & Enoxaparin)
Link  COVID19: Can the DOAC monitoring interval be extended? (Notts CCG)
Link  MHRA: reminder that 15 mg and 20 mg tablets should be taken with food (2019)
Link  NUH Lite Bite: Co-prescribing of anticoagulant and antiplatelet drugs (Oct 18)
Link  NUH: Counselling of patients starting DOACs (pharmacy procedure)
Link  NUH: Haemorrhage or Emergency Surgery guideline for apixaban/edoxaban/rivaroxaban patients
Link  Rivaroxaban dosing table (SFH)
Link  Manufacturers Alert Card for patients (Rivaroxaban only)
Link  Nottinghamshire DOAC alert card
   
Acenocoumarol (Sinthrome)
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Restricted Drug Restricted
Amber 2
Tablet
For patients intolerant of warfarin
 
Link  NUH Lite Bite: Co-prescribing of anticoagulant and antiplatelet drugs (Oct 18)
   
Phenindione
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Restricted Drug Restricted
Amber 2
Tablet
For patients intolerant of warfarin 
Link  NUH Lite Bite: Co-prescribing of anticoagulant and antiplatelet drugs (Oct 18)
   
02.08.02  Expand sub section  Stroke prevention in AF
02.08.02  Expand sub section  VTE treatment
02.08.02  Expand sub section  VTE prophylaxis in hip/knee surgery
 ....
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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