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Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
Notes:
 

Cardiology-related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Cardiology-related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

 

 Details...
02.12  Expand sub section  Lipid-regulating drugs
 note 

BSW STP PCSK9 inhibitors (evolocumab and alirocumab) Blueteq treatment pathway

Alirocumab (Praluent)
(Injection)
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Formulary
Red
High Cost Medicine
CCG
Homecare
BlueTeq
  • 75mg/ml, 150mg/ml solution for injection in a pre filled pen
  • Consultant Lipid specialist only.
  • As an adjunct to diet in primary hypercholesterolaemia or mixed dyslipidaemia: with a statin when LDL-C response to a statin alone is insufficient, and alone or with other lipid-lowering treatments if statins are contraindicated or not tolerated.

 

 

 
Link  NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
Evolocumab (Repatha )
(Injection)
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Formulary
Red
BlueTeq
  • 140mg/ml soln for injection Prefilled SureClick pen, 2 x 1ml
  • Consultant Lipid specialist only.
  • Adjunct to diet in primary hypercholesterolaemia or mixed dyslipidaemia: with a statin when LDL-C response to a statin alone is insufficient, and alone or with other lipid-lowering treatments if statins are contraindicated or not tolerated. With other lipid-lowering treatments in homozygous familial hypercholesterolaemia.
 
Link  NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
02.12  Expand sub section  Bile acid sequestrants
Colestyramine 
(Powder)
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Formulary
Amber
  • Powder 4g sachet (Note: The sugar free sachet is less cost effective)
  • Should only be used for lipid-lowering in exceptional circumstances and be initiated by a consultant. It remains useful in the small number of patients for whom statins cannot be used.

 

 
   
02.12  Expand sub section  Ezetimibe
Ezetimibe 
(Tablet)
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Formulary
Green
  • 10mg
  • Statin Intolerance - In hypersensitivity, elevated LFTs (ALT > 3 times normal limit) or previous myositis, ezetimibe 10mg daily may be substituted as monotherapy. 
  • Ezetimibe should only be prescribed to patients with difficult dyslipidaemia or familial hyperlipidaemia who are failing to reach target cholesterol on high doses of statin, or those who experience true adverse effects from high dose statins or in whom statins are contraindicated

 

 
Link  NICE TA385: Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia
   
02.12  Expand sub section  Fibrates
Bezafibrate 
(Tablet)
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Formulary
Amber
  • Only to be prescribed after having had a telephone consultation with a specialist
  • 200mg, modified release tablets 400mg (Bezalip mono®)
  • NICE. Do not do recomendationDo not routinely offer fibrates for the prevention of CVD to any of the following: -people who are being treated for primary prevention -people who are being treated for secondary prevention -people with CKD -people with type 1 diabetes -people with type 2 diabetes.
 
Link  NICE: Do Not Do Recommendation
   
Fenofibrate 
(Oral)
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Formulary
Amber
  • Only to be prescribed after having had a telephone consultation with a specialist
  • Capsules 67mg, 200mg, 267mg
  • Tablets 160mg
  • NICE. Do not do recomendationDo not routinely offer fibrates for the prevention of CVD to any of the following: -people who are being treated for primary prevention -people who are being treated for secondary prevention -people with CKD -people with type 1 diabetes -people with type 2 diabetes.
 
   
02.12  Expand sub section  Statins to top
Atorvastatin 
(Tablet)
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First Choice
Green
  • 10mg, 20mg, 40mg, 80mg
  • Primary Prevention: New patients offer atorvastatin 20 mg for the primary prevention of CVD to people who have a 10% or greater 10 year risk of developing CVD. Estimate the level of risk using the QRISK2 assessment tool as per NICE CG below.
  • Secondary Prevention: New patients start statin treatment in people with CVD with atorvastatin 80 mg. Use a lower dose of atorvastatin if any of the following apply: potential drug interactions, high risk of adverse effects, patient preference as per NICE CG below.
  • Primary prevention for people with type 1 diabetes as per NICE CG below, start treatment for adults with type 1 diabetes with atorvastatin 20 mg.
  • Primary prevention for people with type 2 diabetes as per NICE CG below, Offer atorvastatin 20 mg to people who have a 10% or greater 10?year risk of developing CVD using the QRISK2 assessment tool
 
Pravastatin  
(Tablet)
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Formulary
Green
  • 10mg, 20mg, 40mg
 
   
Rosuvastatin 
(Tablet)
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Formulary
Green
  • 5mg, 10mg, 20mg, 40mg
  • Not licensed for secondary prevention
 
   
Simvastatin 
(Tablet)
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Formulary
Green
  • 10mg, 20mg, 40mg
  • Maximum recommended dose for simvastatin in combination with amlodipine or diltiazem is 20 mg/day
 
Link  MHRA DSU Dec 2014: Simvastatin: updated advice on drug interactions
   
 ....
 Non Formulary Items
Atorvastatin and Ezetimibe
(Atozet)

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Non Formulary
 
Ciprofibrate (Modalim)

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Non Formulary

NOT RECOMMENDED for off label use for Diabetic Retinopathy

 
Colesevelam 
(Tablet)

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Non Formulary

Note: Colesevelam for Primary Hypercholestrolemia has NOT been included in this formulary. For its use in the treatment of diarrhoea associated with bile salt malabsorption (off label) see section 1.9.2.

 
Colestipol (Colestid)

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Non Formulary

Note: Colestipol for hyperlipidaemias has NOT been included in this formulary. For its use in the treatment of diarrhoea associated with bile salt malabsorption (off label) see section 1.9.2.

 
Fluvastatin (Lescol®)

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Non Formulary
 
Fluvastatin (Lescol® XL)

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Non Formulary
 
Gemifibrozil 

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Non Formulary
 
Gemifibrozil (Lopid®)

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Non Formulary
 
Lomitapide (Lojuxta▼)

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Non Formulary
High Cost Medicine
 
Simvastatin and Ezetimibe
(Inegy)

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Non Formulary
 
  
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 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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Amber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Self

Suitable for patient to be directed to buy themselves  

Grey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Black

Not currently used. We intend to include this TLS in future to highlight where a decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.  

Red Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

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