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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.06.02  Expand sub section  Calcium-channel blockers
Amlodipine
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First Choice
Green
 
Felodipine
(MR Tablets)
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Formulary
Green

  • RPH and CUHFT: non formulary

  • Formulary at all other Trusts and in Primary Care

 
   
Nifedipine
(modified release formulations)
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Formulary
Green

  • Different versions of modified- release preparations may not have the same clinical effect.
  • Prescribers should specify the brand to be dispensed.
  • In Primary Care (February 2020) due to stock availability issues the current formulary choices are:  
    • NIFEDIPRESS MR - Available as a 10mg or 20mg modified release tablet. 
    • ADIPINE XL - Available as a 30mg or 60mg prolonged release tablet.
    • For further information see link below. 
  • Brand in acute trusts as purchased . Please check with Pharmacy.
  • Patients receiving nifedipine for the management of Raynaud's phenomenon should be prescribed a modified-release formulation (off-label) vs. immediate release (licensed). This is due to the increased risk of cardiac complications and mortality with the immediate capsule release profile - see LINK
  • Nifedipine use in pregnancy:
    • NICE guidelines state that where labetalol is not an appropriate first-line treatment, nifedipine may be used to treat hypertension in pregnancy. 
    • However, nifedipine is not specifically licensed for the treatment of hypertension in pregnancy.
    • See links below for further information. 
 
Link  February 2020: Shortages/Discontinuations of Nifedipine products
Link  NICE CKS - Hypertension in Pregnancy (Updated October 2019)
Link  UKTIS - Use of calcium channel blockers in pregnancy
   
Diltiazem
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Formulary
Green

 

  • Standard strength formulations (60mg) are licensed as 'generics' and there is no requirement for brand name dispensing. (In Primary Care prescribe as Tildiem 60mg MR tablets).
  • Diltiazem MR preparations above 60mg strength should be prescribed by brand name because different brands may not have the same clinical effect.
  • 60mg MR preparations have a different release profile to other modified release diltiazem products. Multiples of 60mg tablets/capsules given once or twice daily should not be used to substitute higher strength products.
  • In Primary Care: Prescribe the preferred low cost brand Zemtard XL (ONCE daily).
  • Acute Trusts:  All prescriptions for other brands will be changed to those brands kept by pharmacy, if patients own medication cannot be used on admission. Current brands:

    • Extended release (ONCE daily) - SLOZEM

    • Modified release (TWICE daily) DILZEM SR (non- formulary at NWAFT)

    • Modified release (THREE times daily) generic 60mg diltiazem.


 

 
   
Nifedipine
(Immediate release capsules)
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Restricted Drug Restricted
Red Hospital
  • Short acting capsules Restricted Item Information on restriction :
    • RPH: Restricted for the treatment of refractory autonomic dysreflexia (Hospital only)

 

 

 
Link  February 2020: Shortages/Discontinuations of Nifedipine products
   
Verapamil
(Tablets, MR Tablets, Oral Solution, MR Capsules, Injection)
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Formulary
Green

  • Do not crush MR formulations.

  • Injection (Hospital Only): ECG monitoring required if given as an IV injection

 
Link  What is the evidence for verapamil for prevention of cluster headache?
   
Lercanidipine
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Restricted Drug Restricted
Green

  • RPH: Non formulary

  • CUHFT: May be prescribed by Clinical Pharmacologists for patients who suffer from ankle oedema with other calcium channel blockers.

  • Formulary at all other Trusts and in Primary Care

 
   
Nimodipine
(Tablet, Injection)
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Restricted Drug Restricted
Red Hospital

  • CUHFT and NWAFT: Formulary

    • Injection:Polyethylene, polypropylene, or glass apparatus should be used. PVC should be avoided

    • Tablets: May be crushed or halved but are light sensitive—administer immediately.



  • RPH: Non formulary

 
   
 ....
 Non Formulary Items
Amlodipine and Valsartan  (Exforge)

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Non Formulary
Black

  • Prescribe as individual constituents if required. Combination products are not recommended

 
Lacidipine

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Non Formulary
Grey
 
Nicardipine

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Non Formulary
Grey
 
Nifedipine
(Immediate release capsules)

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Non Formulary
Black
  • For the treatment of refractory autonomic dysreflexia (Hospital only) see monograph above (LINK). 
  • Patients receiving nifedipine for the management of Raynaud's phenomenon should be prescribed a modified-release formulation (off-label) vs. immediate release (licensed). This is due to the increased risk of cardiac complications and mortality with the immediate capsule release profile. 

 

 

Link  February 2020: Shortages/Discontinuations of Nifedipine products
 
Nisoldipine  (Syscor MR)

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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).  

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