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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.08.01  Expand sub section  Parenteral anticoagulants
Argatroban (Exembol®)
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Restricted Drug Restricted
Red Hospital

  • CUHFT and RPH: Anticoagulation in adult patients with heparin-induced thrombocytopenia type II who require parenteral antithrombotic therapy, where fondparinux is not suitable.

  • NWAFT: Non formulary

 
Link  
   
02.08.01  Expand sub section  Heparin
Heparin
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Restricted Drug Restricted
Red Hospital

 

    • CUHFT and NWAFT: For further advice on formulations please contact your Ward or Lead Pharmacist

 

    • RPH only:

 



Heparinised saline flush



10 units/mL



5mL amp



Heparin flush for maintaining patency of ports



100 units/mL



2mL amp



Heparin preservative-free for theatres only



1,000 units/mL



5mL amp



Heparin for clinical perfusionists only



1,000 units/mL



20mL amp



Heparin:




Prophylaxis and treatment of deep vein thrombosis and pulmonary embolism.




Treatment of unstable angina pectoris and prophylaxis of mural thrombosis following myocardial infarction.




In haemofiltration and extracorporeal circulation (bypass and ecmo).



5,000 units/mL



5mL amp



Heparin for cath labs only



1,000 units in NaCl 0.9%



500mL bag

 

 

 

 

 
   
02.08.01  Expand sub section  Low molecular weight heparins
Dalteparin
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First Choice
Advice

 

  • Dalteparin is the LMWH of choice (excluding RPH where Tinzaparin is 1st line).
  • See Trusts guidelines for further information on dosing and duration of treatment.
  • Traffic light status for initiation and continuation of treatment is indication specific. Please see LMWH Prescribing Guideline (THIS GUIDELINE IS CURRENYLY UNDER REVIEW). 
  • For paediatric patients under the age of 16 years, both the prescribing and monitoring of dalteparin should remain - HOSPITAL ONLY. 
  • Patients, irrespective of age, requiring administration of dalteparin from vials, both the prescribing and monitoring should remain - HOSPITAL ONLY.

 

 
Tinzaparin
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Restricted Drug Restricted
Red Hospital

  • RPH: Tinzaparin is the LMWH of choice

  • CUHFT and NWAFT: for use ONLY in the Dialysis Unit to replace unfractionated heparin. ALL other locations/indications: use dalteparin.

  • Non formulary in Primary Care


 

 
   
Enoxaparin
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Restricted Drug Restricted
Amber SCG

 

  • RPH (HOSPITAL ONLY): VTE prophylaxis in patients with renal impairment when creatinine clearance <20ml/min.
  • RPH and Primary Care Shared Care Guideline: For patients undergoing invasive procedures to establish a diagnosis of pulmonary hypertension, assess treatment response or in preparation for surgery. See link below. 
  • Non formulary at all other Trusts and in Primary Care. 
  • Biosimilars available - brand prescribing recommended. 
  • Patients, irrespective of age, requiring administration of enoxaparin from vials, both the prescribing and monitoring should remain -HOSPITAL ONLY
  • For paediatric patients under the age of 16 years, both the prescribing and monitoring of enoxaparin should remain - HOSPITAL ONLY

 

 
Link  RPH: Shared Care Guideline - Enoxaparin for patients undergoing invasive procedures to establish a diagnosis of pulmonary hypertension, assess treatment response or in preparation for surgery
   
02.08.01  Expand sub section  Heparinoids
Danaparoid (Orgaran®)
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Restricted Drug Restricted
Red Hospital

  • CUHFT: Haematologist approval required only if heparin causes thrombocytopenia.

  • NWAFT: Restricted to use in thromboembolic disease in patients with history of heparin-induced thrombocytopenia.

  • RPH: Non formulary.

 
   
02.08.01  Expand sub section  Hirudins to top
 note  RESTRICTED to Dr. Baglin for approximately 3 patients per year for Heparin induced thrombocytopenia and thrombosis (HIT).
Bivalirudin (Angiox®)
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Restricted Drug Restricted
Red Hospital

  • RPH: Formulary

  • Non formulary at all other Trusts

 
Link  NICE TA230: Bivalirudin for the treatment of ST-segment-elevation myocardial infarction
Link  MHRA Drug Safety Update: Risks associated with incorrect dose
Link  NICE CG 94:Unstable angina and NSTEMI
   
02.08.01  Expand sub section  Heparin flushes
 note  Restricted to Dr. Baglin for approximately 3 patients per year for Heparin induced thrombocytopenia and thrombosis (HIT).
http://connect/utilities/action/act_download.cfm?mediaid=17481
Heparin
(Flush)
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Restricted Drug Restricted
Red Hospital

  • RPH and NWAFT: Formulary

  • CUHFT: Restricted to heamatologist recommendation only for Heparin induced thrombocytopenia and thrombosis (HIT). 

 
Link  NPSA Alert: Intravenous Heparin Flush solutions (2008)
Link  SPS: Should heparin based flushing solutions be used in preference to saline to maintain the patency of indwelling intravascular catheters and cannulae?
   
02.08.01  Expand sub section  Epoprostenol
Epoprostenol (Flolan®, Veletri®)
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Restricted Drug Restricted
Red Hospital

  • CUHFT: Restricted to all ICUs.

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

  • NWAFT: Non formulary

 
Link  Clinical Commissioning Policy: National policy for targeted therapies for the treatment of pulmonary hypertension in adults (May 2014)
Link  MHRA Advice: Veletri (epoprostenol) powder for solution for infusion - incompatibilities with some models of administration devices
   
02.08.01  Expand sub section  Fondaparinux
Fondaparinux ( Arixtra®)
( 5mg, 7.5mg, 10mg solution for injection pre-filled syringe)
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Formulary
Red Hospital

  • CUHFT, NWAFT and RPH: Formulary for ACS as per NICE guidelines on unstable angina and NSTEMI. (NWAFT: Where eGFR is less than 30ml/min use dalteparin)

  • CUHFT: Also accepted for use in line with Trust guideline for HIT.

 
Link  NICE Guideline CG94: Unstable angina and NSTEMI - early management
   
 ....
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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