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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.06.01  Expand sub section  Nitrates
Isosorbide Mononitrate MR
(Modified Release)
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First Choice
Green

  • Long acting once daily tablet or capsule

  • Acute Trusts: MR tablets are preferred. 60mg MR tablets are scored for easy administration of 30mg dose if needed.

  • Primary Care: prescribers are asked to prescribe ISMN MR as one of the preferred low cost brands detailed below:


    • 25mg and 50mg MR formulations - Elantan LA25 or LA50 modified-release capsules

    • 40mg MR formulation - Nyzamac SR 40mg modified-release capsules 

    • 60mg MR formulation - Chemydur XL or Monomil XL 60mg modified-release tablets Do not crush MR formulations.


  • Do not crush MR formulations

 
Glyceryl Trinitrate
(Sublingual tablets , Spray, Patches.)
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First Choice
Green

  • Sublingual tablets: Discard tablets 8 weeks after opening bottle

  • Primary Care:


    • Prescribe spray as Glyceryl trinitrate 400micrograms/ dose pump sublingual spray

    • Prescribing of patches in Primary Care should be on the advice of a specialist


 
Isosorbide Mononitrate
(Tablet)
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Formulary
Green

  • Short acting preparations should be administered twice a day with the last dose of the day in the early afternoon (asymmetric dosing) to allow an adequate nitrate-free period and prevent development of tolerance.

  • Prescribe generically

 
   
Isosorbide Dinitrate
(Tablet, MR Tablet, 0.05% Solution for infusion, 0.1% Concentrate for dilution)
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Restricted Drug Restricted
Advice

  • Injection: Hospital only (Glass or polyethylene infusion apparatus is preferable; loss of potency if PVC used)

    • RPH: 0.05% Solution for infusion and 0.1% Concentrate for dilution (For administration by IV infusion only except when administered by an intra-coronary injection during percutaneous coronary intervention) 

    • NWAFT: 0.05% Solution for infusion

    • CUHFT: 0.05% Solution for infusion



  • Oral formulations: Formulary (Specialist advice)


Isosorbide mononitrate is preferred over isosorbide dinitrate as mononitrate preparations are more widely available and isosorbide dinitrate requires more frequent dosing. 

 
   
Glyceryl Trinitrate (Nitrocine)
(Injection)
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Restricted Drug Restricted
Red Hospital

 




    • Injection: Glass or polyethylene apparatus is preferable; loss of potency will occur if PVC is used.



 


 

 
   
 ....
 Non Formulary Items
Glyceryl Trinitrate  (GTN 300 mcg)

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Non Formulary
Grey
 
Isosorbide Dinitrate
(Oral)

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Non Formulary
Grey

Prodrug of isosorbide mononitrate - use that instead.

 
  
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
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Link to adult BNF
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Link to children's BNF
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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).  

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