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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.05  Expand sub section  Drugs affecting the renin-angiotensin system and some other antihypertensive drugs
02.05.01  Expand sub section  Vasodilator antihypertensive drugs
Hydralazine
(Tablets, injections)
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Formulary
Green

  • Injection: Hospital only

 
   
Minoxidil
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Restricted Drug Restricted
Amber No SCG

  • CUHFT: Must be prescribed in addition to a diuretic and a beta blocker

  • Non formulary at all other Trusts

 
   
Tadalafil (Adcirca®)
(Pulmonary hypertension)
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Restricted Drug Restricted
Red Hospital

  • RPH: Restricted to use in pulmonary hypertension only, available via homecare 

  • Non formulary at all other Trusts

 
Link  Clinical Commissioning Policy: National policy for targeted therapies for the treatment of pulmonary hypertension in adults (May 2014)
   
Ambrisentan
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Restricted Drug Restricted
Red Hospital
High Cost Medicine

  • RPH: Restricted to use in pulmonary hypertension only, available via homecare

  • Non formulary at all other Trusts

 
Link  Clinical Commissioning Policy: National policy for targeted therapies for the treatment of pulmonary hypertension in adults (May 2014)
Link  Letters sent to healthcare professionals October 2019: Volibris (ambrisentan) - new patient alert card and removal of the controlled distribution system
   
Iloprost
(Injection)
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Restricted Drug Restricted
Red Hospital
High Cost Medicine

unlicensedunlicensed - Supplied on a named patient basis only



  • RPH: Restricted to Critical Care

  • NWAFT: Formulary.

  • CUHFT: Restricted to:

    • Vasculitis (limb ischaemia)

    • Rheumatology (peripheral vascular disease)



 
Link  Clinical Commissioning Policy: National policy for targeted therapies for the treatment of pulmonary hypertension in adults (May 2014)
Link  Group Prior Approval Forms for CCG Commissioned Indications
Link  NICE Evidence Review ESUOM24: Critical limb ischaemia in peripheral vascular disease (intravenous iloprost)
   
Iloprost nebules (Vantavis®)
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Restricted Drug Restricted
Red Hospital
High Cost Medicine

  • RPH: Restricted to use in pulmonary hypertension only, available via homecare 

  • Non Formulary at all other Trusts


 

 
Link  Clinical Commissioning Policy: National policy for targeted therapies for the treatment of pulmonary hypertension in adults (May 2014)
   
Macitentan (Opsumit® View adult BNF View SPC online View childrens BNF  Track Changes Restricted Drug Restricted
Red Hospital
High Cost Medicine

  • RPH: Restricted to use in pulmonary hypertension only, available via homecare 

  • Non formulary at all other Trusts

 
Link  Clinical Commissioning Policy: National policy for targeted therapies for the treatment of pulmonary hypertension in adults (May 2014)
   
Riociguat (Adempas®)
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Restricted Drug Restricted
Red Hospital
High Cost Medicine

  • RPH: Restricted to use in pulmonary hypertension only, available via homecare

  • Non formulary at all other Trusts

 
Link  NHS England: Targeted Therapies for use in Pulmonary Hypertension in Adults Superseded
   
Sildenafil (Revatio®, Granpidam®)
(Pulmonary hypertension)
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Restricted Drug Restricted
Red Hospital
High Cost Medicine

  • RPH: Restricted to use in pulmonary hypertension only, available via homecare.



  • CUHFT: Intravenous sildenafil is clinically approved for acute pulmonary hypertension in neonates (off-label use) as second line additional agent when nitrous oxide alone ineffective, and patient is NBM so cannot have oral sildenafil. 



  • Non formulary at all other Trusts. 


 

 
Link  Clinical Commissioning Policy: National policy for targeted therapies for the treatment of pulmonary hypertension in adults (May 2014)
Link  MHRA Drug Safety Update: Sildenafil (Revatio and Viagra): reports of persistent pulmonary hypertension of the newborn (PPHN) following in-utero exposure in a clinical trial on intrauterine growth restriction
   
Sodium Nitroprusside
View adult BNF  Track Changes
Restricted Drug Restricted
Red Hospital

  • CUHFT: Restricted to hypertensive crisis unlicensedunlicensed 

  • Non Formulary at all other Trusts


 


 

 
   
Tolazoline
(Injection)
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Restricted Drug Restricted
Red Hospital

  • CUHFT: Restricted to neonatal use only. Named patient use only. unlicensed unlicensed

  • Non formulary at all other Trusts 

 
   
Bosentan
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Restricted Drug Restricted
Red Hospital
High Cost Medicine

  • RPH: Restricted to use in pulmonary hypertension only, available via homecare 

  • CUHFT: Restricted to the treatment of digit ulceration in systemic sclerosis. Prior approval required (NHSE)

  • Non formulary at all other Trusts and in Primary Care


 

 
Link  Clinical Commissioning Policy: National policy for targeted therapies for the treatment of pulmonary hypertension in adults (May 2014)
Link  Clinical Commissioning Policy: Treatment of Digital Ulceration in Systemic Sclerosis
   
Sildenafil (Generic)
(Digital ulcers)
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Restricted Drug Restricted
Amber No SCG

 



 




    • Prescribe generically as 25mg or 50mg tablets. (DO NOT PRESCRIBE 20mg tablets for this indication)



 




    • Non-formulary at all other Trusts for this indication



 




    • For other indications see seperate entry



 

 
Link  Clinical Commissioning Policy: Sildenafil and bosentan for the treatment of digital ulceration in systemic sclerosis
Link  NICE Evidence summary: Sildenafil for digital ulcers
Link  MHRA Drug Safety update: Sildenafil (Revatio and Viagra): reports of persistent pulmonary hypertension of the newborn (PPHN) following in-utero exposure in a clinical trial on intrauterine growth restriction
   
02.05.02  Expand sub section  Centrally acting antihypertensive drugs
Methyldopa
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Formulary
Green

 

  • Should only be used for hypertension where other agents have failed or are not suitable.
  • Methyldopa use in pregnancy:
    • Methyldopa may be indicated in the treatment of hypertension or gestational hypertension.
    • Methyldopa is not specifically licensed for the treatment of hypertension in pregnancy. However, the manufacturer states that methyldopa can be used during pregnancy if there is no safer alternative available.
    • NICE guidelines identify labetalol as the preferred antihypertensive for use during pregnancy. 
    • See links below for further information. 
 
Link  NICE CKS - Hypertension in Pregnancy (Updated October 2019)
Link  UKTIS - Use of methyldopa in pregnancy
   
Clonidine
(Injection)
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Restricted Drug Restricted
Red Hospital

  • CUHFT: Restricted for the maintenance of sedation in ICU. unlicensed unlicensed

  • NWAFT: Specialist use only

  • RPH: Restricted to

    • Hypertensive crisis.

    • Restlessness and agitation in critically ill patients. unlicensed unlicensed




See Section 4 for prophylaxis of migraine, attention deficit-hyperactivity disorder (unlicensed unlicensed) and Tourette’s syndrome (unlicensed unlicensed).

 
   
02.05.03  Expand sub section  Adrenergic neurone blocking drugs
02.05.04  Expand sub section  Alpha-adrenoceptor blocking drugs to top
Doxazosin
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First Choice
Green

  • Immediate release only. Modified release tablets are non formulary.

  • Dose should be started low and titrated up.

 
Prazosin
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Restricted Drug Restricted
Advice

 

  • Doxazosin is the 1st line choice of alpha blocker.
  • CUHFT: Formulary.
  • Non formulary at all other Trusts.

October 2020 - Shortage of Prazosin (Hypovase) 1mg tablets

  • Hypovase 1mg tablets are out of stock with resupply date to be confirmed. 
  • Hypovase 500mcg tablets are currently available.
 
   
02.05.04  Expand sub section  Phaeochromocytoma
Phenoxybenzamine
(Capsules)
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Restricted Drug Restricted
Red Hospital

  • CUHFT and NWAFT: Restricted to hypertension in phaeochromocytoma only.

  • Non formulary at all other Trusts


Owing to risk of contact sensitisation healthcare professionals should avoid contamination of hands.

 
   
Phentolamine
(antihypertensive)
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Restricted Drug Restricted
Red Hospital

 




    • CUHFT and NWAFT: Formulary



 




    • Non formulary at all other Trusts



 

 
Link  Summary of Product Characteristics (SPC): Phentolamine mesilate solution for injection
   
02.05.05  Expand sub section  Drugs affecting the renin-angiotensin system
02.05.05.01  Expand sub section  Angiotensin-converting enzyme inhibitors (ACE inhibitors)
Lisinopril
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First Choice
Green
 
Ramipril
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First Choice
Green

 

  • Primary Care: prescribe as capsules. 

 

 
Enalapril
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Formulary
Green

 

  • NWAFT: Restricted to existing patients and paediatric use.
  • Formulary at all other Trusts where 1st line choices are unsuitable.

October 2020 - Supply Difficulties with Enalapril 20mg tablets

  • Supplies are currently available from Aurobindo.
  • Dexcel and Noumed are currently out of stock with resupply expected by w/c 9 November 2020 and early 2021, respectively.
  • There will be ongoing constraints with supplies of enalapril 20mg tablets until November 2020 when more manufacturers are back in stock.
  • Specialist importers can source unlicensed products. Lead times may vary.
  • See Medicine Supply Notification below (issued 24/07/2020) for further actions to be taken in relation to this shortage. 

 

 
Link  Medicine Supply Notification July 2020: Enalapril 20mg tablets (published 24/07/2020)
   
Perindopril erbumine
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Formulary
Green

  • Please prescribe generic.

  • NWAFT: non formulary


Perindopril arginine is non formulary in all Trust and Primary Care 

 
Link  Items which should not routinely be prescribed in primary care: Perindopril Arginine
Link  PrescQIPP: Switching from Coversyl® Arginine products (perindopril arginine) to perindopril erbumine tablets
   
Captopril
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber No SCG

  • CUHFT: Accepted on Formulary for use by cardiologists for ACEI test dose; not for treatment. (Hospital only)

  • RPH: Restricted to the treatment of refractory autonomic dysreflexia

  • NWAFT: formulary

 
   
02.05.05.02  Expand sub section  Angiotensin-II receptor antagonists
Losartan
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First Choice
Green
 
Candesartan
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Second Choice
Green
 
   
Sacubitril / valsartan ( Entresto ®)
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Restricted Drug Restricted
Amber No SCG

  • Specialist initiation by Heart Failure Specialist with access to MDT as per NICE TA388

 
Link  NICE TA388: Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction
Link  Prescribing Support: Sacubitril/valsartan (Entresto)
   
Valsartan
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Restricted Drug Restricted
Advice

 

  • NWAFT: Formulary (capsules).
  • RPH: Formulary (capsules).
  • Non formulary at all other Trusts.
  • Prescribe as capsules in Primary Care.

 

 
   
Irbesartan
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Restricted Drug Restricted
Advice

  • CUHFT: Formulary

  • Non formulary at all other Trusts

 
   
02.05.05.03  Expand sub section  Renin inhibitors to top
 ....
 Non Formulary Items
Aliskiren

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Non Formulary
Black

 

  • Not included in NICE hypertension guideline as insufficient evidence of its effectiveness.
  • See also safety concerns (see links below).
  • Prescribers in Primary Care should not initiate aliskiren for any new patient.

  • Patients currently prescribed aliskiren should be reviewed by their specialist/initiating trust and aliskiren deprescribed.

  • CUHFT have withdrawn their current shared care guideline.

     

 

 

Link  EMA advise clinicians to review Aliskiren prescribing following termination of ALTITUDE study
Link  MHRA: Aliskiren (Rasilez): risk of angioedema and renal dysfunction
Link  MHRA: Aliskiren (Rasilez): risk of cardiovascular and renal adverse reactions—new contraindications and warnings
 
Azilsartan

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Non Formulary
Grey
 
Captopril and Hydrochlorothiazide  (Capozide®)

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Non Formulary
Grey
Link  MHRA Drug Safety Update: Hydrochlorothiazide- risk of non-melanoma skin cancer, particularly in long-term use
 
Captopril and Hydrochlorothiazide  (Co-zidocapt®)

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Non Formulary
Grey
Link  MHRA Drug Safety Update: Hydrochlorothiazide: risk of non-melanoma skin cancer, particularly in long-term use
 
Clonidine
(Tablets)

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Non Formulary
Grey
  • See Section 4 for prophylaxis of migraine, attention deficit-hyperactivity disorder (unlicensed unlicensed) and Tourette’s syndrome (unlicensed unlicensed).

June 2020 - Shortage of Clonidine 25microgram tablets

  • Accord are out of stock and unable to advise a resupply date.
  • Sandoz have stock available which is being sent to wholesalers - Ethigen, Lexon and AAH. 
  • See link below for further information.
Link  June 2020: Shortage of Clonidine 25microgram tablets
 
Cozaar- Comp®
(Losartan & hydrochlorothiazide)

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Non Formulary
Grey
 
Enalapril and Hydrochlorothiazide  (Innozide®)

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Non Formulary
Grey
Link  MHRA Drug Safety Update: Hydrochlorothiazide: risk of non-melanoma skin cancer, particularly in long-term use
 
Eprosartan

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Non Formulary
Grey
 
Fosinopril

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Non Formulary
Grey
 
Guanethidine Monosulphate

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Non Formulary
Grey

  • Non formulary at all Trusts

  • BNF recommends guanethidine monosulfate is less suitable for prescribing.

 
Iloprost  (Colonis)
(100mcg/ml concentrate for solution for infusion)

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Non Formulary
Grey
  • RPH: New Product Assessment taking place by RPH. Existing unlicensed product will continue to be issued in the interim.
  • Iloprost 100 micrograms/ml Concentrate for solution for infusion is NOT ready to use and requires dilution before administration. 

 

 
Imidapril  (Tanatril®)

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Non Formulary
Grey
 
Indoramin

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Non Formulary
Grey
 
Indoramin  (Doralese®)

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Non Formulary
Grey
 
Lisinopril and Hydrochlorothiazide  (Carace® Plus)

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Non Formulary
Grey
Link  MHRA Drug Safety Update: Hydrochlorothiazide - risk of non-melanoma skin cancer, particularly in long-term use
 
Lisinopril and Hydrochlorothiazide  (Lisicostad®)

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Non Formulary
Grey
Link  MHRA Drug Safety Update: Hydrochlorothiazide: risk of non-melanoma skin cancer, particularly in long-term use
 
Lisinopril and Hydrochlorothiazide  (Zestoretic®)

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Non Formulary
Grey
Link  MHRA Drug Safety Update: Hydrochlorothiazide: risk of non-melanoma skin cancer, particularly in long-term use
 
Moexipril

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Non Formulary
Grey
 
Moxonidine

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Non Formulary
Grey
 
Olmesartan

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Non Formulary
Grey
 
Perindopril Arginine

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Non Formulary
Grey
 
Quinapril

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Non Formulary
Grey
 
Quinapril and Hydrochlorothiazide

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Grey
Link  MHRA Drug Safety Update: Hydrochlorothiazide - risk of non-melanoma skin cancer, particularly in long-term use
 
Ramipril and Felodipine  (Triapin®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Grey
 
Rasitro®
(Aliskeren / amlodipine / hydrochlorothiazide )

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Grey
Link  MHRA Drug Safety Update: Hydrochlorothiazide- risk of non-melanoma skin cancer, particularly in long-term use
 
Sevikar HCT®
(Olmesartan / amlodipine / hydrochlorothiazide )

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Grey
Link  MHRA Drug Safety update: Hydrochlorothiazide - risk of non-melanoma skin cancer, particularly in long-term use
 
Telmisartan

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Non Formulary
Grey
 
Terazosin

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Non Formulary
Grey
 
Trandolapril

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Non Formulary
Grey
 
Trandolapril and Verapamil  (Tarka®)

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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

OTC

Available Over the Counter. Consider Self Care   

Green

Formulary - Can be prescribed in both secondary and primary care.   

Advice

Formulary - Specialist Advice, secondary care advice provided for primary care initiation.  

Amber No SCG

Formulary - Specialist initiation without shared care guidance.  

Amber SCG

Formulary - Specialist initiation with shared care guidance.  

Red Hospital

Restricted - Hospital only, not to be prescribed in primary care.  

Switch

Not recommended for prescribing. Switch to alternative cost-effective option.   

Black

Not recommended for prescribing in primary or secondary care.  

Grey

Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.   

Non Formulary

Non-Formulary (category under review).  

netFormulary