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 Formulary Chapter 2: Cardiovascular system - Full Chapter
Chapter Links...
Link   Local Process for warfarin to DOAC switch_April 2020
Link   DOAC Counselling Checklist
Link   National Guidance: Warfarin to DOAC switching _ April 2020
Link   Warfarin to DOAC switching _ Local Guidance _ April 2020
Link   NICE CG187: Acute heart failure: diagnosis and management
Link   UKMI: MI - secondary prevention - Summary of NICE guidance (CG172)
 Details...
02.09  Expand sub section  Antiplatelet drugs
Aspirin (antiplatelet)
(Dispersible Tablets)
View adult BNF View SPC online View childrens BNF  Track Changes 		First Choice
OTC

 

  • Aspirin dispersible and EC tablets (75mg) can be purchased from a Community Pharmacist. 
  • Pregnant women at an increased risk of preeclampsia at their booking appointment should be offered a prescription of 75mg - 150mg aspirin to be taken each night from 12 weeks of pregnancy until birth (off-label use):
    • Please note Community pharmacies cannot legally sell aspirin as a Pharmacy Only Medicine for prevention of pre-eclampsia in pregnancy in England.
    • Aspirin for this indication must be prescribed.
    • Please see links below for further information. 

 

 
Link  Aspirin’s effect on reducing cancer risk
Link  Bandolier: risks vs benefits of low dose aspirin review
Link  Can nonsteroidal anti-inflammatory drugs be used in adult patients with asthma?
Link  Is there Evidence to Support the use of Enteric Coated (EC) Aspirin to Reduce Gastrointestinal Side Effects in Cardiovascular Patients?
Link  NHS England: Saving Babies Lives - Version 2 (March 2019)
   
Clopidogrel
View adult BNF View SPC online View childrens BNF  Track Changes 		Formulary
Green

  • GI risks very similar to aspirin.

  • Prescribe generically

  • Use in the following circumstances:

    • People who have had an ischaemic stroke or who have peripheral arterial disease or multivascular disease (as per NICE TA210)

    • Following MI only if aspirin is contra-indicated or not tolerated

    • Proven gastro-intestinal haemorrhage with low dose aspirin.

    • For cardiologists to treat patients who have had an acute coronary syndrome (ACS).



 
Link  MHRA: Clopidogrel - risk of acquired haemophilia
Link  MHRA: Clopidogrel and proton pump inhibitors - interaction, updated advice
Link  NICE Evidence Summary ESUOM23: Clopidogrel for transient ischaemic attack
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
Link  CUH Prescribing of antiplatelets in non-ST elevation acute coronary syndrome (ACS)
   
Dipyridamole (Modified Release Capsules)
View adult BNF View SPC online View childrens BNF  Track Changes 		Restricted Drug Restricted
Advice

  • Recommended as per NICE TA210 (modified-release dipyridamole)

  • Only if alternatives are not appropriate for the individual patient.

 
Link  NICE TA210 Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
   
Prasugrel
View adult BNF View SPC online View childrens BNF  Track Changes 		Restricted Drug Restricted
Amber No SCG 		 
Link  NICE TA317: Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes
Link  MHRA Advice: Prasugrel (Efient) - increased risk of bleeding
Link  MHRA Advice: Prasugrel (Efient) - rare but serious hypersensitivity reactions
   
Ticagrelor
View adult BNF View SPC online View childrens BNF  Track Changes 		Restricted Drug Restricted
Amber No SCG

  • Specialist Initiation only as per:

    • NICE TA236 for the treatment of acute coronary syndromes

    • NICE TA420 for preventing atherothrombotic events after myocardial infarction.



  • A Prescribing Support Document is available.


 

 
Link  NICE TA236: Ticagrelor for the treatment of acute coronary syndromes
Link  NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction
Link  Prescribing Support Document: Ticagrelor for the treatment of acute coronary syndromes
   
Tirofiban
View adult BNF View SPC online View childrens BNF  Track Changes 		Restricted Drug Restricted
Red Hospital

  • RESTRICTED to Cardiologists only - for the management of Acute Coronary Syndrome as per NICE TA47


 

 
Link  NICE TA47: Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes
   
Abciximab
View adult BNF View SPC online View childrens BNF  Track Changes 		Restricted Drug Restricted
Red Hospital

  • RPH: Formulary

  • CUHFT: Approved only for Dr. Higgins to treat FOUR patients annually for thrombo-embolic complications of neuro-surgery. All other uses at CUHFT non formulary.

  • NWAFT: Non Formulary

 
Link  NICE TA47: Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes
   
 link Link    NICE Clincal Guideline CG180: Atrial fibrillation: management
 link Link    NICE Clincal Guideline CG95: Chest pain of recent onset: assessment and diagnosis
 link Link    NICE Clinical Guideline CG172: Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease
 link Link    NICE Clinical Guideline CG94: Unstable angina and NSTEMI - early management
 link Link    NICE TA210: Clopidogrel and dipyridamole for prevention of occlusive vascular events
 link Link    CUH Perioperative management of antiplatelet and anticoagulant treatment
 link Link    CUH Prescribing of antiplatelets in non-ST elevation acute coronary syndrome (ACS)
 ....
 Non Formulary Items
Cangrelor

View adult BNF View SPC online View childrens BNF Track Changes 		Non Formulary
Black

  • NICE TA351: Cangrelor for reducing atherothrombotic events in people undergoing percutaneous coronary intervention or awaiting surgery requiring interruption of anti‑platelet therapy (terminated appraisal). No evidence submission was received from The Medicines Company.
Link  NICE TA351: Reducing Artherothrombotic Events
 
Eptifibatide

View adult BNF View SPC online View childrens BNF Track Changes 		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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