Kingston Hospital NHS FoundationTrust and Kingston CCG. Joint Medicines Formulary

Transcription

1 Kingston Hospital NHS FoundationTrust and Kingston CCG Joint Medicines Formulary Published Version 3 November 2013 Approved by Kingston CCG Medicines Management Committee Kingston Hospital NHS FoundationTrust Drug and Therapeutics Group

2 CONTENTS FOREWORD NICE TECHNOLOGY ADHERENCE.12 ABBREVIATIONS AND SYMBOLS USED IN THE FORMULARY EMERGENCY TREATMENT OF POISONING HOW TO SEARCH FOR A DRUG IN THE FORMULARY CONTENTS OF EMERGENCY DRUGS BOXES GASTRO-INTESTINAL SYSTEM - CHAPTER Dyspepsia and Gastro-Oesophageal Reflux Disease Antacids and Simeticone Compound Alginates and Proprietary Indigestion Preparations Antispasmodics and Other Drugs Altering Gut Motility Antisecretory Drugs and Mucosal Protectants H 2 -Receptor Antagonists Chelates and Complexes Selective Antimuscarinics Prostaglandin Analogues Proton Pump Inhibitors Acute Diarrhoea Antimotility Drugs Chronic Bowel Disorders Aminosalicylates Corticosteroids Drugs Affecting The Immune Response Food Allergy Laxatives Bulk-Forming Laxatives Stimulant Laxatives Faecal Softeners Osmotic Laxatives Bowel Cleansing Preparations HT 4 Receptor Agonists and guanylate cyclase-c receptor antagonists Local Preparations for Anal and Rectal Disorders Soothing Haemorrhoidal Preparations Compound Haemorrhoidal Preparations With Corticosteroid Rectal Sclerosants Management of Anal Fissures Drugs Affecting Intestinal Secretions Drugs Affecting Biliary Composition and Flow Bile Acid Sequestrants Pancreatin...23 Other Preparations...23 KH-KCC Joint formulary Published Version 3 Nov 13 1

3 2.0 CARDIOVASCULAR SYSTEM - CHAPTER Positive Inotropic Drugs Cardiac Glycosides Phosphodiesterase Inhibitors Diuretics Thiazides and Related Diuretics Loop Diuretics Potassium-Sparing Diuretics and Aldosterone Antagonists Potassium-Sparing Diuretics with Other Diuretics Osmotic Diuretics Anti-Arrhythmic Drugs Drugs for Arrhythmias Beta-Adrenoceptor Blocking Drugs Hypertension and Heart Failure Vasodilator Antihypertensive Drugs Centrally Acting Antihypertensive Drugs Adrenergic Neurone Blocking Drugs Alpha-Adrenoceptor Blocking Drugs Drugs Affecting the Renin-Angiotensin System Angiotensin-Converting Enzyme Inhibitors Angiotensin-Ii Receptor Antagonists (Arbs) Nitrates, Calcium-Channel Blockers and Other Antianginal Drugs Nitrates Calcium-Channel Blockers Other Antianginal Drugs Peripheral Vasodilators and Related Drugs Sympathomimetics Inotropic Sympathomimetics Vasoconstrictor Sympathomimetics Cardiopulmonary Resuscitation Anticoagulants and Protamine Parenteral Anticoagulants Oral Anticoagulants NPSA Protamine Sulphate Antiplatelet Drugs Stable Angina, Acute Coronary Syndromes and Fibrinolysis Fibrinolytic Drugs Antifibrinolytic Drugs and Haemostatics Lipid-Regulating Drugs Local Sclerosants Other Cardiovascular Drugs...32 KH-KCC Joint formulary Published Version 3 Nov 13 2

4 3.0 RESPIRATORY SYSTEM - CHAPTER Bronchodilators Adrenoceptor Agonists Selective Beta 2 -Agonists Antimuscarinic Bronchodilators Theophylline Peak Flow Meters, Inhaler Devices and Nebulisers Corticosteroids Cromoglicate, Related Therapy and Leukotriene Receptor Antagonists Leukotriene Receptor Antagonists Antihistamines, Hyposensitisation and Allergic Emergencies Antihistamines Allergic Emergencies Respiratory Stimulants and Pulmonary Surfactants Respiratory Stimulants Pulmonary Surfactants Mucolytics Cough Preparations Cough Suppressants Expectorant and Demulcent Cough Preparations Systemic Nasal Decongestants Miscellaneous CENTRAL NERVOUS SYSTEM - CHAPTER Hypnotics and Anxiolytics Hypnotics Anxiolytics Drugs Used in Psychoses and Related Disorders Antipsychotic Drugs Antipsychotic Depot Injections Drugs used for mania and hypomania Antidepressant Drugs Tricyclic and Related Antidepressant Drugs Monoamine-Oxidase Inhibitors (MAOIs)* Selective Serotonin Re-Uptake Inhibitors Other Antidepressant Drugs Cns Stimulants and Drugs Used for Attention Deficit Hyperactivity Disorder Drugs Used in the Treatment of Obesity Anti-Obesity Drugs Acting on the Gastro-Intestinal Tract Drugs Used in Nausea and Vertigo Analgesics Non-Opioid Analgesics Opioid Analgesics Neuropathic Pain...43 KH-KCC Joint formulary Published Version 3 Nov 13 3

5 4.7.4 Antimigraine Drugs Treatment of Acute Migraine Prophylaxis of Migraine Antiepileptic Drugs Control of Epilepsy Drugs Used in Status Epilepticus Drugs Used in Parkinsonism and Related Disorders Dopaminergic Drugs Used in Parkinsonism Antimuscarinic Drugs Used in Parkinsonism Drugs Used in Essential Tremor, Chorea, Tics and Related Disorders Drugs Used in Substance Dependence Drugs for Dementia INFECTIONS CHAPTER 5 (for local agents see Chapters 7, 11, 12 & 13) Antibacterial Drugs Penicillins Benzylpenicillin and Phenoxymethylpenicillin Penicillinase-Resistant Penicillins Broad-Spectrum Penicillins Antipseudomonal Penicillins Cephalosporins, Carbapenems and Other Beta-Lactams Cephalosporins Carbapenems Other Beta-Lactam Antibiotics Tetracyclines Aminoglycosides Macrolides Clindamycin Some Other Antibacterials Sulphonamides and Trimethoprim Antituberculous Drugs Hospital Prescribing Only Antileprotic Drugs Metronidazole and Tinidazole Quinolones Urinary-Tract Infections Antifungal Drugs Antiviral Drugs Human Immunodeficiency Virus (HIV) Infection Hospital Prescribing Only Herpesvirus Infections Herpes Simplex and Varicella-Zoster Infection Cytomegalovirus (CMV) Viral Hepatitis Hospital Prescribing Only Chronic Hepatitis B Chronic Hepatitis C Influenza 56 KH-KCC Joint formulary Published Version 3 Nov 13 4

6 5.4.5 Respiratory Syncytial Virus Antiprotozoal Drugs Antimalarials Amoebicides Drugs for Toxoplasmosis Drugs for Pneumocystis Pneumonia Anthelmintics Drugs for Threadworms Ascaricides (Common Roundworm Infections) Drugs for Hookworms Schistosomicides (Bilharziasis) Filaricides Drugs for Cutaneous Larva Migrans (Creeping Eruption) ENDOCRINE SYSTEM - CHAPTER Drugs Used in Diabetes Insulins Short Acting Insulins Intermediate and Long-Acting Insulins Hypodermic Equipment Oral Antidiabetic Drugs Sulphonylureas Biguanides Other Antidiabetic Drugs Treatment of Hypoglycaemia Treatment of Diabetic Nephropathy and Neuropathy Diagnostic and Monitoring Agents for Diabetes Mellitus Thyroid and Antithyroid Drugs Thyroid Hormones Antithyroid Drugs Corticosteroids Replacement Therapy Glucocorticoid Therapy Sex Hormones Female Sex Hormones Oestrogens and HRT Progestogens Male Sex Hormones and Antagonists Anabolic Steroids Hypothalamic & Pituitary Hormones & Anti-Oestrogens Hypothalamic & Anterior Pituitary Hormones & Anti-Oestrogens Posterior Pituitary Hormones and Antagonists Drugs Affecting Bone Metabolism Calcitonin and Parathyroid Hormone Bisphosphonates and Other Drugs Affecting Bone Metabolism...63 KH-KCC Joint formulary Published Version 3 Nov 13 5

7 6.7 Other Endocrine Drugs Bromocriptine and Other Dopaminergic Drugs Drugs Affecting Gonadotrophins Metyrapone and Trilostane OBSTETRICS, GYNAECOLOGY AND URINARY-TRACT DISORDERS - CHAPTER Drugs Used in Obstetrics Prostaglandins and Oxytocics Ductus Arteriosus Mifepristone Myometrial Relaxants Treatment of Vaginal and Vulval Conditions Preparations for Vaginal and Vulval Changes Vaginal and Vulval Infections Contraceptives Combined Hormonal Contraceptives Progestogen-Only Contraceptives Oral Progestogen-Only Contraceptives Parenteral Progestogen-Only Contraceptives Intra-Uterine Progestogen-Only Device Spermicidal Contraceptives Contraceptive Devices Emergency Contraception Drugs for Genito-Urinary Disorders Drugs for Urinary Retention Drugs for Urinary Frequency, Enuresis and Incontinence Drugs Used in Urological Pain Bladder Instillations and Urological Surgery Drugs for Erectile Dysfunction MALIGNANT DISEASE AND IMMUNOSUPPRESSION - CHAPTER Cytotoxic Drugs Alkylating Drugs Anthracyclines and Other Cytotoxic Antibiotics Antimetabolites Vinca Alkaloids and Etoposide Other Antineoplastic Drugs Drugs Affecting the Immune Response Antiproliferative Immunosuppressants Corticosteroids and Other Immunosuppressants Rituximab and Alemtuzumab Other Immunomodulating Drugs Sex Hormones and Hormone Antagonists in Malignant Disease Oestrogens Progestogens Hormone Antagonists...73 KH-KCC Joint formulary Published Version 3 Nov 13 6

8 Breast Cancer Gonadorelin Analogues and Gonadotrophin-Releasing Hormone Somatostatin Analogues NUTRITION AND BLOOD - CHAPTER Anaemias and Some Other Blood Disorders Iron-Deficiency Anaemias Oral Iron Parenteral Iron Drugs Used in Megaloblastic Anaemias Drugs Used in Hypoplastic, Haemolytic and Renal Anaemias Drugs Used in Platelet Disorders Drugs Used in Neutropenia Fluids and Electrolytes Oral Preparations for Fluid and Electrolyte Imbalance Oral Potassium Oral Sodium and Water Oral Bicarbonate Parenteral Preparations for Fluid and Electrolyte Imbalance Electrolytes and Water Plasma and Plasma Substitutes Intravenous Nutrition Oral Nutrition / Foods for Special Diets and Enteral Nutrition - See Appendix Minerals Calcium and Magnesium Calcium Supplements Hypercalcaemia and Hypercalciuria Magnesium Phosphorus Phosphorus Suppliments Zinc Vitamins Vitamin B Group Vitamin C (Ascorbic Acid) Vitamin D Vitamin E Vitamin K Multivitamin Preparations Metabolic Disorders Drugs Used in Metabolic Disorders MUSCULOSKELETAL AND JOINT DISEASES - CHAPTER Drugs Used in Rheumatic Diseases and Gout Non-Steroidal Anti-Inflammatory Drugs Corticosteroids...84 KH-KCC Joint formulary Published Version 3 Nov 13 7

9 Systemic Corticosteroids Local Corticosteroid Injections Drugs that Suppress the Rheumatic Disease Process Gout and Cytotoxic-Induced Hyperuricaemia Drugs Used in Neuromuscular Disorders Drugs Which Enhance Neuromuscular Transmission Skeletal Muscle Relaxants Drugs for the Relief of Soft-Tissue Inflammation Enzymes Rubefacients and Other Topical Antirheumatics EYE - CHAPTER Anti-Infective Eye Preparations Antibacterials Antivirals Corticosteroids and Other Anti-Inflammatory Preparations Corticosteroids Other Anti-Inflammatory Preparations Mydriatics and Cycloplegics Treatment of Glaucoma Local Anaesthetics Miscellaneous Ophthalmic Preparations Tear Deficiency, Ocular Lubricants and Astringents Ocular Diagnostic, Peri-Operative Preparations and Photodynamic...91 Treatment EAR, NOSE AND OROPHARYNX - CHAPTER Drugs Acting on the Ear Otitis Externa Removal of Ear Wax Drugs Acting on the Nose Drugs Used in Nasal Allergy Topical Nasal Decongestants Nasal Preparations for Infection and Epistaxis Drugs Acting on the Oropharynx Drugs for Oral Ulceration and Inflammation Oropharyngeal Anti-Infective Drugs Lozenges and Sprays Mouthwashes, Gargles and Dentifrices Treatment of Dry Mouth SKIN - CHAPTER Management of Skin Conditions Vehicles Emollient and Barrier Preparations Emollients...96 KH-KCC Joint formulary Published Version 3 Nov 13 8

10 Emollient Bath Additives and Shower Preparations Barrier Preparations Topical Local Anaesthetics and Antipruritics Topical Corticosteroids Preparations for Eczema and Psoriasis Preparations for Eczema Preparations for Psoriasis Drugs Affecting the Immune Reponse Acne and Rosacea Topical Preparations for Acne Oral Preparations for Acne Preparations for Warts and Calluses Sunscreens and Camouflagers Sunscreening Preparations Shampoos and Other Preparations for Scalp and Hair Conditions Anti-Infective Skin Preparations Antibacterial Preparations Antibacterial Preparations Only Used Topically Antibacterial Preparations Also Used Systemically Antifungal Preparations Antiviral Preparations Parasiticidal Preparations Preparations for Minor Cuts and Abrasions Skin Cleansers, Antiseptics and Desloughing Agents Alcohols and Saline Chlorhexidine Salts Iodine Oxidisers and Dyes Desloughing Agents Antiperspirants Miscellaneous Preparations IMMUNOLOGICAL PRODUCTS AND VACCINES - CHAPTER Vaccines and Antisera Immunoglobulins ANAESTHESIA - CHAPTER General Anaesthesia Intravenous Anaesthetics Inhalational Anaesthetics Antimuscarinic Drugs Sedative and Analgesic Peri-Operative Drugs Anxiolytics and Neuroleptics Non-Opioid Analgesics Opioid Analgesics Neuromuscular Blocking Drugs KH-KCC Joint formulary Published Version 3 Nov 13 9

11 Drugs for Reversal of Neuromuscular Blockade Antagonists for Central and Respiratory Depression Drugs for Malignant Hyperthermia Local Anaesthesia BASIC PATIENT CARE ITEMS 1089 DIALYSIS (HAEMOFILITRATION) FLUIDS 1099 COMPLIANCE AIDS 1099 MISCELLANEOUS 1099 BORDERLINE SUBSTANCES - APPENDIX WOUND MANAGEMENT PRODUCTS - APPENDIX KH-KCC Joint formulary Published Version 3 Nov 13 10

12 FOREWORD The Formulary is a list of medicines, dressings and dietary products which have been approved for use by the Trust s Drug and Therapeutic Group/Kingston CCG Medicines Management Committee. Drugs subject to a NICE Technology Appraisal require an application to the DTG, if applicable, in order to agree a local prescribing process for that drug. While the local prescribing process is being agreed, medicines subject to a NICE TA will be made available for prescribing. They will require approval by a Senior Pharmacy Manager prior to supply. The formulary includes a NICE technology adherence spreadsheet which will be updated when new NICE TA recommendations about medicines are published. The products listed are routinely stocked by Kingston Hospital Pharmacy Department and are available to all prescribers unless otherwise indicated. The numbering system and the format used for the Formulary is the same as that used by the British National Formulary (BNF). The products under each heading are listed alphabetically and intended for quick reference. The Formulary does not provide prescribing information. It highlights under specific drugs when a Trust Prescribing Guideline is available. It is intended to be used in conjunction with the Trust s Medicines Management Policy, current BNF and the Trust s Guidelines for the Management of Common Medical Emergencies and for the Use of Antimicrobial Drugs. Medicines which are not listed in the Formulary are non-formulary medicines. The only exceptions to use a non-formulary medicine are: When patient is admitted on a non-formulary medicine and the patient s own supply is not available or deemed unsuitable; Medicines undergoing a Clinical Trial supported by the Trust; Specialist therapy for an individual patient agreed by a Senior Pharmacy Manager after discussion with the Consultant (unless a PbR exclusion drug). The requesting consultant will be asked to complete a new product request form if the request is for an unlicensed medicine; black triangle medicine; or high cost drug. In the case of an unlicensed medicine, a risk assessment will be undertaken by the Pharmacy Department and the Drug and Therapeutics Group notified of the request; If the non-formulary medicine is requested for more than one patient within the same clinical division, the Chair of Drug and Therapeutics Group/Senior Pharmacy Manager will discuss with the requesting consultant and forward a new product request form for completion where appropriate. An independent evaluation will then be undertaken by the Pharmacy Department for the drug to be discussed at a Drug and Therapeutic Group meeting. The Consultant will be invited to present his / her submission at the meeting and a decision will be made as to the formulary status and place of therapy of the medicine. If the medicine is proposed to be used in primary care, approval will be needed from Kingston CCG. New strengths and new formulations will be added to the Formulary at the discretion of a Senior Pharmacy Manager and requesting consultant if relevant. KH-KCC Joint formulary Published Version 3 Nov 13 11

13 NICE TECHNOLOGY ADHERENCE NICE TA Adherence Checklist vn4.5 Nov 1 ABBREVIATIONS AND SYMBOLS USED IN THE FORMULARY A AP BWO CAO NPSA MRHA P Stock held in Accident and Emergency only Stock held in A & E and Pathology only Bladder wash out Consultant approval only National Patient Safety Agency s Alert or Rapid Response Report available on the preparation Medicines and Healthcare Products Regulatory Agency Stock held in Pathology only PbR Excl Payment by results excluded drug UNLIC Unlicensed medicine Preparations considered by BNF Joint Formulary Committee to be less suitable for prescribing KH-KCC Joint formulary Published Version 3 Nov 13 12

14 EMERGENCY TREATMENT OF POISONING AT KINGSTON HOSPITAL KEY: A = stock held in Accident and Emergency only P = stock held in Pathology only AP = stock held in A & E and Pathology only Removal and Elimination Charcoal, activated powder (50g) KLEAN PREP sachets Specific Drugs Analgesics (Non-opioid) Paracetamol Acetylcysteine injection (200mg/ml, 10ml) Methionine tablets (500mg) Salicylates Sodium bicarbonate infusion (1.26%) injection (8.4%, 10ml amps) capsules (500mg) Analgesics (Opioid) Naloxone injection (400micrograms/ml, 1ml) Benzodiazepines Flumazenil injection (100micrograms/ml, 5ml) Beta-blockers Glucagon injection (1 unit/vial) UNLIC Isoprenaline injection (2.5mg/ml) Heparin Protamine sulphate injection (5mg/5ml) Iron Salts Desferrioxamine injection (500mg) Isoniazid UNLIC Pyridoxine injection injection 100mg/2ml Local anesthetic toxicity INTRALIPID intravenous infusion (20%, 500ml) Methotrexate Calcium folinate injection 50mg/5ml KH-KCC Joint formulary Published Version 3 Nov 13 13

15 Phenothiazines and related Drugs Procyclidine injection (10mg/2ml) Sulphonylureas Octreotide injection 50micrograms/ml Other Poisons Cyanides AP Dicobalt edetate injection (15mg/ml, 20ml) A Sodium nitrite injection (3%) UNLIC Ethylene glycol Alcohol dehydrated injection (5ml) UNLIC Fomepizole injection (5mg/ml) Hydrofluoric acid burns Calcium gluconate gel (2.5%) injection (10%, 10ml) Calcium chloride prefilled syringe (10%,10ml) Organophosphorus insecticides Atropine injection (600micrograms/ml, 1ml) Serotonin syndrome Cyproheptadine tablets 4mg KH-KCC Joint formulary Published Version 3 Nov 13 14

16 HOW TO SEARCH FOR A DRUG IN THE FORMULARY You can search quickly for a drug in the formulary by using the search function. To do this you need to hold down the Ctrl key and type F. You will see the following screen. In the Find what box you need to type in the name of the drug you would like to search for and then click on Find next as in the example below. You will now be directed to the relevant part of the formulary where the drug is listed. If you want to check if the drug is also listed elsewhere, you can continue to click on Find next. If the drug is not found, it means that it is not on the formulary. KH-KCC Joint formulary Published Version 3 Nov 13 15

17 CONTENTS OF EMERGENCY DRUGS BOXES AT KINGSTON HOSPITAL Adult Blue Box 8 x Adrenaline (epinephrine) pre-filled syringes 1 in 10,000, 10ml 1 x Amiodarone pre-filled syringe 300mg in 10ml 3 x Atropine sulphate pre-filled syringes 1mg in 10ml 1 x Calcium chloride pre-filled syringe 10%, 10ml Anaphylaxis / Other Emergency 2 amps Adrenaline (epinephrine) 1 in 1000, 1ml 2 amps Chlorphenamine 10mg/ml, 1ml 2 amps Hydrocortisone 100mg/ml, 1ml 1 amp Naloxone 400micrograms/ml, 1ml Adult critical care packs for intubation Etomidate injection 2mg/ml (1 box) Magnesium sulphate 50% (1 minijet or ampoule) Metaraminol injection 10mg/ml (1 box) Midazolam injection 5mg/5ml (1 box) Propofol injection 1% (20ml) (1 box) Sodium bicarbonate 8.4% (1 minijet or ampoule) Atracurium injection 50mg/5ml (1 box) Suxamethonium injection 100mg/ml (2 syringes or 2 amps) Paediatric UNLIC UNLIC 2 amps Adenosine injection 3mg/ml, 2ml 3 amps Adrenaline (epinephrine) injection 1 in 10,000, 10ml 1 amp Adrenaline (epinephrine) injection 1 in 1,000, 10ml 2 amps Atropine sulphate 600micrograms/ml injection, 1ml 3 amps Sodium bicarbonate 8.4% injection, 10ml 2 amps Amiodarone 50mg/ml injection, 3ml 2 amps Magnesium sulphate 50% injection, 2ml Paediatric Anaphylaxis Kit UNLIC 3 amps Adrenaline (epinephrine) injection 1 in 1000, 10ml 2 amps Chlorphenamine (chlorpheniramine) injection 10mg/ml, 1ml 2 amps Hydrocortisone 100mg/ml injection, 1ml 2 respirator solution Salbutamol 5mg in 2.5ml Neonatal Emergency Drug Pack UNLIC UNLIC 2 amps Adrenaline (epinephrine) injection 1 in 10,000, 10ml 2 amps Naloxone 400micrograms/ml injection, 1ml 2 amps Sodium bicarbonate 4.2% injection, 10ml 4 amps Glucose 10% injection, 10ml 2 amps Sodium Chloride 0.9% injection, 10ml KH-KCC Joint formulary Published Version 3 Nov 13 16

18 Paediatic anaesthetic emergency pack 2 amps Atropine sulphate injection 600mcg/1ml 1 amp Dopamine injection 200mg/5ml 2 amps Ketamine injection 200mg/20ml 2 amps Midazolam injection 5mg/5ml 1 ampsthiopentone injection 500mg 2 amps Water for injection (20ml) Anaphylactic shock pack for adults and children in the community 3 amps Adrenaline (epinephrine) injection 1 in 1000, 1ml Hypo boxes 1 x 500g box of powdered glucose 1 x packet of biscuits 1 x 100ml vial of 20% glucose. 1 x hanger for the 20% glucose 1 x giving set 1 x laminated card KH-KCC Joint formulary Published Version 3 Nov 13 17

19 1.0 GASTRO-INTESTINAL SYSTEM - CHAPTER Dyspepsia and gastro-oesophageal reflux disease 1.2 Antispasmodics and other drugs altering gut motility 1.3 Antisecretory drugs and mucosal protectants 1.4 Acute diarrhoea 1.5 Chronic bowel disorders 1.6 Laxatives 1.7 Local preparations for anal and rectal disorders 1.8 Stoma care (no entry in the formulary) 1.9 Drugs affecting intestinal secretions 1.1 DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE Sodium citrate mixture (0.3 Molar) ANTACIDS AND SIMETICONE COMPOUND ALGINATES AND PROPRIETARY INDIGESTION PREPARATIONS GAVISCON s/f infant sachets (sodium alginate 225mg, aluminium hydroxide 112.5mg, magnesium alginate 87.5mg/dose [= half a dual-sachet]) Advance liquid (sodium alginate 500mg, potassium bicarbonate 100mg, calcium carbonate 100mg/5ml. Contains 2.3 mmol sodium and 1mmol potassium/5ml) PEPTAC Suspension (sodium alginate 250mg, sodium bicarbonate 133.5mg, calcium carbonate 80mg/5ml. Contains 3.1mmol sodium/5ml) - 1 st choice in primary care 1.2 ANTISPASMODICS AND OTHER DRUGS ALTERING GUT MOTILITY Atropine sulphate injection (600micrograms/ml, 1ml) Dicycloverine (Dicyclomine) tablets (10mg) hydrochloride Dicycloverine (Dicyclomine) syrup (10mg/5ml) Domperidone tablets (10mg) suspension (5mg/5ml) suppositories (30mg) Hyoscine butylbromide tablets (10mg) injection (20mg/ml, 1ml) Mebeverine hydrochloride tablets (135mg) Metoclopramide tablets (10mg) s/f syrup (5mg/5ml) injection (5mg/ml, 2ml) Peppermint Oil capsules UNLIC Peppermint water (100ml) hospital prescribing only KH-KCC Joint formulary Published Version 3 Nov 13 18

20 1.3 ANTISECRETORY DRUGS AND MUCOSAL PROTECTANTS H 2 -RECEPTOR ANTAGONISTS Ranitidine tablets (150mg) effervescent tablets (150mg) injection (25mg/ml, 2ml) s/f syrup (75mg/5ml) CHELATES AND COMPLEXES Sucralfate tablets (1g) suspension (1g/5ml) Tripotassium dicitratobismuthate* tablets (120mg) *Restricted to use in the second line H. pylori eradication therapy regimen (see below: 1.3.5) SELECTIVE ANTIMUSCARINICS UNLIC Pirenzepine* tablets (20mg) *Restricted for clozapine induced hypersalivation when hyoscine is not appropriate PROSTAGLANDIN ANALOGUES Misoprostol tablets (200micrograms) PROTON PUMP INHIBITORS Omeprazole capsules (10mg, 20mg) - 1 st line MUPS tablets* (10mg, 20mg) *Restricted to patients with swallowing problems or enteral tubes Lansoprazole capsules (15mg, 30mg) oro-dispersible tablets* (15mg, 30mg) *Restricted to patients with swallowing problems or enteral tubes and is the first line for this group of patients. 1 st line H. pylori eradication regime Amoxicillin 1g bd* Clarithromycin 500mg bd Omeprazole 20mg bd for 7 days *If penicillin allergic, use metronidazole 400mg bd instead of amoxicillin 2 nd line H. pylori eradication regime (used only after 1 st line failure) Oxytetracycline 500mg qds Metronidazole 400mg tds Omeprazole 20mg bd Tripotassium dicitratobismuthate 120mg qds for 14 days Omeprazole infusion (40mg) Acute Trust Guidelines available for the 72 hour infusion for the management of recurrent peptic ulcer bleeding (unlicensed) KH-KCC Joint formulary Published Version 3 Nov 13 19

21 1.4 ACUTE DIARRHOEA ANTIMOTILITY DRUGS Loperamide hydrochloride capsules (2mg) - 1 st line s/f syrup (1mg/5ml) Codeine phosphate tablets (15mg, 30mg) syrup (25mg/5ml) 1.5 CHRONIC BOWEL DISORDERS AMINOSALICYLATES Mesalazine e/c tablets (OCTASA MR, 400mg) - 1 st line for new patients e/c tablets (ASACOL MR, 400 mg, 800mg) m/r tablets (PENTASA, 500mg) foam enema (ASACOL, 1g) retention enema (PENTASA, 1g/100ml) suppositories (ASACOL, 500mg) suppositories (PENTASA, 1g) Sulfasalazine tablets (500mg) e/c tablets (500mg) CORTICOSTEROIDS Budesonide m/r capsules (3mg) Hydrocortisone foam (10%, 25g) Prednisolone enemas (20mg/100ml) foam (20mg, 25g) UNLIC suppositories (5mg) DRUGS AFFECTING THE IMMUNE RESPONSE Restricted to the gastroenterology team: Azathioprine tablets (25mg, 50mg) Ciclosporin capsules ( DEXCEL brand, 25mg, 50mg, 100mg) - 1 st line for new patients (NEORAL brand, 25mg, 50mg, 100mg) Brand prescribing and dispensing required for haematology patients Ciclosporin injection (50mg/ml, 1ml) Acute Trust Guidelines available for the use of I.V. and oral ciclosporin in severe corticoid resistant ulcerative colitis Mercaptopurine tablets (50mg) Methotrexate tablets (2.5mg) Ulcerative colitis (acute exacerbations) - infliximab (NICE TA163) Crohn's disease - infliximab (review) and adalimumab (review of TA40) (NICE TA187) CAO Adalimumab injection (40mg) PbR Excl CAO Infliximab infusion (100mg) PbR Excl KH-KCC Joint formulary Published Version 3 Nov 13 20

22 1.5.4 FOOD ALLERGY CAO Sodium cromoglicate* capsules (100mg)-hospital prescribing only * Restricted to the gastroenterology team for eosinophilic oesophagitis (unlicensed indication) 1.6 LAXATIVES BULK-FORMING LAXATIVES Ispaghula husk s/f granules (3.5g/sachet) STIMULANT LAXATIVES Bisacodyl e/c tablets (5mg) suppositories (5mg, 10mg) Docusate sodium capsules (100mg) s/f solution (50mg/5ml) s/f paediatric solution (12.5mg/5ml) enema (120mg/10g) Glycerin (Glycerol) suppositories (1g, 2g, 4g) Senna tablets (Sennoside B 7.5mg) s/f syrup (Sennoside B 7.5mg/5ml) Sodium picosulfate elixir (5mg/5ml) Restricted to palliative care use only: Co-danthramer capsules (25/200: Dantron 25mg, Poloxamer '188' 200mg) suspension (25/200 in 5ml: Dantron 25mg, Poloxamer '188' 200mg/5ml) Strong capsules (37.5/500: Dantron 37.5mg, Polaxamer mg) Strong suspension (75/1000 in 5ml: Dantron 75mg, Polaxamer 188, 1g/5ml) FAECAL SOFTENERS Arachis oil enema (130ml) OSMOTIC LAXATIVES Lactulose solution (3.35g/5ml) Liquid paraffin and Magnesium hydroxide MACROGOLS emulsion BP LAXIDO oral powder (Macrogol g, Sodium bicarbonate 178.5mg, Sodium chloride 350.7mg, Potassium chloride 46.6mg/sachet) MOVICOL PAEDIATRIC PLAIN oral powder (Macrogol g, Sodium bicarbonate 89.3mg, Sodium chloride 175.4mg, Potassium chloride 23.3mg/sachet) Phosphate enema (Sodium acid phosphate 10%, Sodium phosphate 8% in water) MICRALAX micro enema (5ml, Sodium citrate 450mg, Sodium alkylsulphoacetate 45mg, Sorbic acid 5mg, together with glycerol and sorbitol) KH-KCC Joint formulary Published Version 3 Nov 13 21

23 1.6.5 BOWEL CLEANSING PREPARATIONS MOVIPREP oral powder (Sachet A containing macrogol g, anhydrous sodium sulphate 7.5g, sodium chloride 2.691g, potassium chloride 1.015g) and Sachet B containing ascorbic acid 4.7g, sodium ascorbate 5.9g) PICOLAX s/f oral powder (Sodium picosulfate 10mg/sachet with magnesium citrate) HT 4 RECEPTOR AGONISTS Constipation (women) - prucalopride (NICE TA211) Prucalopride* tablets (1mg, 2mg) * Not for hospital initiation; patients to be referred to primary care prescribers for clinical assessment to prescribe prucalopride against the NICE criteria 1.7 LOCAL PREPARATIONS FOR ANAL AND RECTAL DISORDERS SOOTHING HAEMORRHOIDAL PREPARATIONS ANUSOL cream (Bismuth oxide 2.14%, Peru balsam 1.8%, Zinc oxide 10.75%, 23g) ointment (Bismuth subgallate 2.25%, Bismuth oxide 0.87%, Zinc oxide 10.75%, Peru balsam 1.87%, 25g) suppositories (Bismuth oxide 24mg, Bismuth subgallate 59mg, Peru balsam 49mg, Zinc oxide 296mg) COMPOUND HAEMORRHOIDAL PREPARATIONS WITH CORTICOSTEROID ANUSOL-HC ointment (as for ANUSOL plus Hydrocortisone 0.25%, Benzylbenzoate 1.25%, 30g) UNIROID- HC suppositories (Cinchocaine hydrochloride 5mg, hydrocortisone 5mg) RECTAL SCLEROSANTS UNLIC Phenol in glycerin injection (5%, 10ml) Acute Trust, available on request Phenol in oil injection (5%, 5ml) UNLIC Phenol in water injection (6%, 5ml) MANAGEMENT OF ANAL FISSURES UNLIC Glyceryl trinitrate ointment (0.2%) 1 st line treatment of anal fissures UNLIC Diltiazem cream (2%) 2 nd line treatment of anal fissures in patients who are unable to tolerate headache with GTN 1.8 DRUGS AFFECTING INTESTINAL SECRETIONS DRUGS AFFECTING BILIARY COMPOSITION AND FLOW Ursodeoxycholic acid tablets (150mg) capsules (250mg) suspension (250mg/5ml) KH-KCC Joint formulary Published Version 3 Nov 13 22

24 1.8.2 BILE ACID SEQUESTRANTS Colestyramine sachets (4g) PANCREATIN CREON 10,000 capsules (Providing: protease 600 units, lipase 10,000 units, amylase 8,000 units,) CREON 40,000 capsules (Providing: protease 1,600 units, lipase 40,000 units, amylase 25,000 units) OTHER PREPARATIONS Bethanechol* tablets (10mg) * Restricted to Paediatric team for refractory gastric reflux disease. CLOTEST testing strip KH-KCC Joint formulary Published Version 3 Nov 13 23

25 2.0 CARDIOVASCULAR SYSTEM - CHAPTER Positive inotropic drugs 2.2 Diuretics 2.3 Anti-arrhythmic drugs 2.4 Beta-adrenoceptor blocking drugs 2.5 Hypertension and heart failure 2.6 Nitrates, calcium channel blockers, and other antianginal drugs 2.7 Sympathomimetics 2.8 Anticoagulants and protamine 2.9 Antiplatelet drugs 2.10 Stable angina, acute coronary syndromes and fibrinolysis 2.11 Antifibrinolytic drugs and haemostatics 2.12 Lipid-regulating drugs 2.13 Local sclerosants 2.14 Other cardiovascular drugs 2.1 POSITIVE INOTROPIC DRUGS CARDIAC GLYCOSIDES Digoxin tablets (62.5micrograms, 125micrograms, 250micrograms) elixir (250micrograms/5ml) injection (250micrograms/ml, 2ml) Digoxin-specific antibody DIGIFAB injection (40mg) PHOSPHODIESTERASE INHIBITORS CAO Milrinone* injection (10mg/10ml) *Restricted to ITU consultants only 2.2 DIURETICS THIAZIDES AND RELATED DIURETICS Bendroflumethazide tablets (2.5mg, 5mg) UNLIC Chlorothiazide* suspension (250mg/5ml) * Restricted to paediatrics and neonates Indapamide tablets (2.5mg) UNLIC Metolozone * tablets (5mg) *Restricted to cardiologist recommendation LOOP DIURETICS Bumetanide tablets (1mg) Furosemide tablets (20mg, 40mg) s/f oral solution (5mg/5ml UNLIC, 40mg/5ml) injection (10mg/ml, 2ml, 5ml, 25ml) KH-KCC Joint formulary Published Version 3 Nov 13 24

26 2.2.3 POTASSIUM-SPARING DIURETICS AND ALDOSTERONE ANTAGONISTS Amiloride tablets (5mg) s/f oral solution (5mg/5ml) Spironolactone tablets (25mg, 100mg) UNLIC s/f suspension (50mg/5ml) Eplerenone* tablets (25mg) *Restricted to cardiologist initiation only South London Cardiac and Stroke Networks Prescribing Guidelines available at POTASSIUM-SPARING DIURETICS WITH OTHER DIURETICS Not to be used as first line therapy, only for those where compliance is considered a problem: Co-amilofruse 5/40 tablets (Amiloride 5mg, Furosemide 40mg) Co-amilofruse 2.5/20 tablets (Amiloride 2.5mg, Furosemide 20mg) OSMOTIC DIURETICS Mannitol intravenous infusion (10%, 20%, 500ml) 2.3 ANTI-ARRHYTHMIC DRUGS DRUGS FOR ARRHYTHMIAS Adenosine injection (3mg/ml, 2ml) infusion (130mg/130ml)* * Restricted to cardiac nuclear medicine only Amiodarone Hydrochloride tablets (100mg, 200mg) injection (50mg/ml, 3ml) Atrial fibrillation - dronedarone (NICE TA197) CPO Dronedarone tablets (400mg) Flecainide Acetate tablets (50mg, 100mg) injection (10mg/ml, 15ml) Propafenone tablets (150mg) For atropine sulphate see section For cardiac glycosides see section For beta-adrenoceptor blockers see section 2.4 For verapamil see section BETA-ADRENOCEPTOR BLOCKING DRUGS Hospital prescribing only, available on request where alternatives are unsuitable Indication Drug Dose Heart Failure South London Cardiac and Stroke Networks Prescribing Guidelines available at 1 st line 2 nd line Bisoprolol Carvedilol Licensed dose range, titrated up to the maximum tolerated dose according to product licence. Licensed dose range, titrated up to the maximum tolerated dose according to product licence. Post Myocardial Infarction 1 st line Metoprolol (not MR) As per BNF 2 nd line Propranolol (not MR) As per BNF KH-KCC Joint formulary Published Version 3 Nov 13 25

27 Hypertension and Angina Angina Atenolol Metoprolol Atenolol Metoprolol Propranolol As per BNF As per BNF As per BNF As per BNF For people with concurrent conditions such as migraine, tremor anxiety, etc Atenolol tablets (25mg, 50mg, 100mg) s/f syrup (25mg/5ml) Bisoprolol Fumarate tablets (1.25mg, 2.5mg, 5mg) Carvedilol tablets (3.125mg, 6.25mg, 12.5mg) Labetalol hydrochloride tablets (50mg, 100mg, 200mg) injection (5mg/ml, 20ml) Metoprolol Tartrate tablets (50mg) injection (1mg/ml, 5ml) Propranolol hydrochloride tablets (10mg, 40mg, 80mg, 160mg) m/r capsules (80mg, 160mg) syrup (50mg/5ml) Sotalol hydrochloride* tablets (40mg, 80mg) *Restricted to use for treating ventricular arrhythmias or prophylaxis of supraventricular arrhthmyias Esmolol hydrochloride* injection (10mg/ml, 10ml) UNLIC injection (250mg/ml, 10ml) *Restricted to anaesthetics only for intra operative use for the rapid decrease of blood pressure 2.5 HYPERTENSION AND HEART FAILURE VASODILATOR ANTIHYPERTENSIVE DRUGS Hydralazine hydrochloride tablets (25mg, 50mg) injection (20mg) UNLIC Sodium nitroprusside injection (50mg/2ml, 2ml) UNLIC Iloprost* injection (50micrograms/0.5ml) CAO *Restricted use Acute Trust Prescribing Guidelines available CAO Sildenafil* tablets (20mg) *Restricted for pulmonary arterial hypertension hospital prescribing only, available on request CENTRALLY ACTING ANTIHYPERTENSIVE DRUGS Clonidine injection (150micrograms/ml, 1ml) tablets (100micrograms) Methyldopa tablets (500mg) ADRENERGIC NEURONE BLOCKING DRUGS UNLIC Guanethidine Monosulphate injection (10mg/ml, 1ml) ALPHA-ADRENOCEPTOR BLOCKING DRUGS Doxazosin tablets (1mg, 2mg, 4mg) Phenoxybenzamine capsules (10mg) hydrochloride Phentolamine mesilate injection (10mg/ml, 1ml) KH-KCC Joint formulary Published Version 3 Nov 13 26

28 2.5.5 DRUGS AFFECTING THE RENIN-ANGIOTENSIN SYSTEM ANGIOTENSIN-CONVERTING ENZYME INHIBITORS Indication Drug Dose Post Myocardial Infarction 1 st line Ramipril Titrate up to 10mg total daily dose Heart Failure South London Cardiac and Stroke Networks Prescribing Guidelines available at 1 st line Ramipril Titrate up to 10mg total daily dose Other indications Ramipril As per BNF Enalapril As per BNF Lisinopril As per BNF Captopril tablets (12.5mg) Enalapril tablets (2.5mg, 5mg, 10mg, 20mg) Lisinopril tablets (2.5mg, 5mg, 10mg, 20mg) Perindopril tablets (2mg, 4mg, 8mg) Ramipril capsules (1.25mg, 2.5mg, 5mg, 10mg) ANGIOTENSIN-II RECEPTOR ANTAGONISTS (ARBs) To be used second line for patients intolerant of ACE inhibitors: Losartan potassium tablets (25mg, 50mg) 1 st line ARB for hypertension Candesartan tablets (2mg, 4mg, 8mg, 16mg) ARB of choice in heart failure. South London Cardiac and Stroke Networks Prescribing Guidelines available at Irbesartan tablets (75mg, 150mg), if losartan or candesartan not appropriate 2.6 NITRATES, CALCIUM-CHANNEL BLOCKERS, AND OTHER ANTIANGINAL DRUGS NITRATES Glyceryl trinitrate s/l tablets (500micrograms) injection (1mg/ml, 5ml, 50ml) aerosol spray (400micrograms/dose) patches (5mg/24 hours) Isosorbide mononitrate tablets (10mg, 20mg) m/r tablets (60mg) m/r capsules (25mg, 40mg) CALCIUM-CHANNEL BLOCKERS Indication Drug Dose Heart Failure with concurrent angina 1 st line Amlodipine Licensed dose range Hypertension 1 st line Amlodipine or Licensed dose range LA nifedipine 2 nd line Diltiazem or verapamil Licensed dose range Angina or hypertension 1st line MR Diltiazem Licensed dose range KH-KCC Joint formulary Published Version 3 Nov 13 27

29 2 nd line or 1 st line in LVF Amlodipine Licensed dose range 3 rd line MR or LA Nifedipine Licensed dose range Amlodipine tablets (5mg, 10mg) Diltiazem hydrochloride m/r tablets (60mg) m/r capsules (TILDIEM LA, 200mg, 300mg) 1 st line long acting diltiazem brand m/r tablets m/r capsules (TILDIEM RETARD, 90mg,120mg) 2 nd line long acting diltiazem brand (ADIZEM-XL, 120mg) (Acute Trust, other brands will be purchased for patients admitted on other brands if required) Nifedipine capsules (5mg, 10mg) m/r tablets (ADALAT LA, 30mg) m/r tablets (ADALAT RETARD, 10mg, 20mg) m/r tablets (NIFEDIPRESS M/R, 10mg, 20mg) (Acute Trust, other brands will be purchased for patients admitted on other brands if required) Nimodipine tablets (30mg) infusion (200micrograms/ml, 5ml) Verapamil tablets (40mg, 120mg) m/r tablets (SECURON, 120mg, 240mg) injection (2.5mg/ml, 2ml) OTHER ANTIANGINAL DRUGS Nicorandil* tablets (10mg, 20mg) * Reserved for use when other anti-anginals (beta-blockers and calcium channel blockers) are contraindicated, not tolerated or do not fully control symptoms. Chronic Heart Failure-Ivabadine (NICE TA 267) Ivabradine* tablets (5mg) * Restricted to cardiologist initation only for patients that cannot tolerate either beta-blockers or rate limiting calcium channel blockers (diltiazem/verapamil) and to be used in line with NICE Clinical Guidelines on the Management of Stable Angina South London Cardiac and Stroke Networks Prescribing Guidelines available at Ranolazine* m/r tablets (375mg, 500mg available on request) * Restricted to cardiologist initation only for patients that cannot tolerate either beta-blockers or rate limiting calcium channel blockers (diltiazem/verapamil) and to be used in line with NICE Clinical Guidelines on the Management of Stable Angina PERIPHERAL VASODILATOR AND RELATED DRUGS Peripheral arterial disease - cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate (NICE TA223) Naftidrofuryl oxalate capsules (100mg) Pentoxifylline (oxpentifylline)* m/r tablets (400mg) hospital prescribing only * On specialist recommendation for liver patients only to prevent hepatorenal syndrome, dose - 400mg tds for not more than 21 days. KH-KCC Joint formulary Published Version 3 Nov 13 28

30 2.7 SYMPATHOMIMETICS INOTROPIC SYMPATHOMIMETICS UNLIC Isoprenaline hydrochloride injection (2.25mg/2ml) Dobutamine* injection (250mg/50ml) concentrate for intravenous infusion (250mg/20ml) Dopamine hydrochloride* injection (40mg/ml, 5ml) *Restricted to monitored patients only CAO Dopexamine hydrochloride* injection (10mg/ml, 5ml) *Restricted to ITU consultants only Selective Phosphodiesterase III Inhibitors UNLIC Levosimendan* injection (12.5mg/5ml) *Restricted to use by ITU consultants only to wean patients with cardiac failure from the ventilator and provide inotropic support. Acute Trust Prescribing Guidelines available VASOCONSTRICTOR SYMPATHOMIMETICS Ephedrine hydrochloride injection (30mg/ml, 1ml) pre-filled syringe (3mg/ml, 10ml) Metaraminol tartrate injection (10mg/ml, 1ml) Noradrenaline/Norepinephrine injection (1mg/ml, 4ml) Phenylephrine hydrochloride injection (10mg/ml, 1ml) CARDIOPULMONARY RESUSCITATION Adrenaline (Epinephrine) injection (1 in 1,000, 1ml) UNLIC injection (1 in 1,000, 10ml) UNLIC injection (1 in 10,000, 10ml) minijet (1 in 10,000, 10ml) 2.8 ANTICOAGULANTS AND PROTAMINE PARENTERAL ANTICOAGULANTS See Acute Trust Guidelines in The Blue Book for Common Medical Emergencies Heparin Heparin calcium injection (5000 units/0.2ml) Heparin sodium injection (1000 units/ml, 1ml, 5ml, 20ml) infusion (2 units/ml in sodium chloride 0.9%, 500ml) Low molecular weight heparins For treatment of DVT, PE and Unstable Angina Dalteparin sodium pre-filled syringes (2500units/0.2ml, 5000 units/0.2ml, 7,500units/0.3ml, 10,000 units/0.4ml, 12,500 units/0.5ml, 15,000 units/0,6ml, 18,000 units/0.72ml)-hospital prescribing only injection (10,000 units/ml, 1ml ampoule)-hospital prescribing only Heparinoids Danaparoid sodium* injection(750 units in 0.6ml) Acute Trust HIT Guidelines available. *Restricted to recommendation from ITU consultants and haematologists in patients with heparin induced thrombocytopenia (HIT) KH-KCC Joint formulary Published Version 3 Nov 13 29

31 Heparin flushes NPSA Heparin sodium* solution (10units/ml, 5ml; 100units/ml, 2ml) *Restricted to flushing arterial and central venous catheters only Epoprostenol Epoprostenol* infusion (500micrograms) *Restricted to ITU and Neonatal Unit for pulmonary hypertension only Fondaparinux Fondaparinux sodium*pre-filled syringes (5mg/ml, 0.5ml) *Restricted to use for unstable angina and non ST-segment elevation myocardial infarction ORAL ANTICOAGULANTS NPSA Acenocoumarol (Nicoumalone) tablets (1mg) Atrial fibrillation - dabigatran etexilate (NICE TA249) CAO Dabigatran tablets (110mg, 150mg) Atrial fibrillation (stroke prevention) - rivaroxaban (NICE TA256) Venous thromboembolism (treatment and long term secondary prevention) - rivaroxaban (NICE TA261) CAO Rivaroxaban tablets (15mg, 20mg) Stroke and systemic embolism (prevention, non-valvular atrial fibrillation) - apixaban (NICE TA275) CAO Apixaban tablets (2.5mg, 5mg) Dabigatran, rivaroxaban and apixaban to be prescribed in line with SLSCN guidance, restricted to prescribing by cardiologists, haematologists and elderly care consultants only. Transfer of care checklist used for AF NPSA Warfarin Sodium tablets (1mg, 3mg, 5mg) Acute Trust Guidelines in The Blue Book of Medical Emergencies and the anticoagulant drug chart PROTAMINE SULPHATE Protamine sulphate injection (10mg/ml, 5ml) 2.9 ANTIPLATELET DRUGS Acute coronary syndromes - glycoprotein IIb/IIIa inhibitors (review) (NICE TA47) Partially updated by CG94 Abciximab* injection (10mg) *Restricted to use ONLY in patients awaiting transfer for percutaneous coronary intervention (PCI) Aspirin dispersible tablets (75mg, 300mg) e/c tablets* (75mg) * Not recommended for initiation Vascular disease - clopidogrel and dipyridamole (NICE TA210) KH-KCC Joint formulary Published Version 3 Nov 13 30

32 Clopidogrel tablets (75mg) Where initiated in the management of acute coronary syndrome (ACS); an antiplatelet card will be issued to patients with the planned treatment duration For patients at high risk of developing gastric erosions taking clopidogrel, treat with an H 2 - antagonists such as ranitidine in preference to a PPI. If concomitant use of a PPI is essential, avoid omeprazole and use lansoprazole. See South London Cardiac and Stroke Network Guidance on Prescribing Gastroprotection for Patients Taking Clopidogrel at Dipyridamole m/r capsules (200mg) Dipyridamole suspension (50mg/5ml)* * Restricted to patients with fine bore nasogastric(ng) tubes Dipyridamole tablets (100mg)* *Restricted to patients who cannot swallow m/r capsules Acute coronary syndrome - prasugrel (NICE TA182) Prasugel tablets (5mg, 10mg)- Acute Trust; available on request South London Cardiac and Stroke Networks Prescribing Guidelines available at Acute coronary syndromes - ticagrelor (NICE TA236) Ticagrelor tablets (90mg)- Acute Trust; available on request South London Cardiac and Stroke Networks Prescribing Guidelines available at STABLE ANGINA, ACUTE CORONARY SYNDROMES, AND FIBRINOLYSIS FIBRINOLYTIC DRUGS Ischaemic stroke (acute) - alteplase (NICE TA264) Update to TA 122 CAO Alteplase injection (50mg) Streptokinase* injection (1,500,000 units) *For management of pulmonary embolism and empyema (unlicensed indication) Urokinase injection (10,000 units) Myocardial infarction - thrombolysis (NICE TA52) Tenecteplase injection (40mg, 50mg) 2.11 ANTIFIBRINOLYTIC DRUGS AND HAEMOSTATICS Etamsylate tablets (500mg) Tranexamic acid tablets (500mg) UNLIC syrup (500mg/5ml) injection (100mg/ml, 5ml) Blood-related Products CAO Recombinant Factor VIIa* injection (NOVOSEVEN, 2mg, 5mg) PbR Excl *Restricted to ITU & haematology consultants only Acute Trust Prescribing Guidelines Available KH-KCC Joint formulary Published Version 3 Nov 13 31

33 2.12 LIPID-REGULATING DRUGS Cardiovascular disease - statins (NICE TA94) Statins Pravastatin tablets (10mg, 20mg, 40mg) Simvastatin* tablets (10mg, 20mg, 40mg) Atorvastatin tablets (10mg, 20mg, 40mg, 80mg) * See MHRA Drug Safety Update August 2012 for updated advice on drug interactions CAO Rosuvastatin* tablets (5mg, 10mg, 20mg) * Reserved for initiation by consultant cardiologists or lipidologists in the Acute Trust for the management of hypercholesterolaemia. Restricted for patients where simvastatin, pravastatin and atorvastatin are contra-indicated or as recommended in NICE clinical guidelines and South London Cardiac and Stroke Network guidance. South London Cardiac and Stroke Networks Prescribing Guidelines available at Bile acid sequestrants Colestyramine (Cholestyramine) powder (4g sachet) Ezetemibe Hypercholesterolaemia - ezetimibe (NICE TA132) Ezetimibe* tablets (10mg) * Restricted to use in primary hypercholesterolaemia as an add-on therapy when the maximum dose of statin does not reduce LDL/total cholesterol levels down to target or when indicated patients are intolerant of statins. Fibrates Bezafibrate tablets (200mg) m/r tablets (400mg) Fenofibrate (micronised) capsules (200mg) South London Cardiac and Stroke Network Hypertriglyceridaemia Pathway at Omega-3 fatty acid compounds Omacor * Capsules (1g Omega-3-acid ethyl esters) *Restricted to patients who have had an MI within 3 months and are not achieving 7 g of omega 3 fatty acids per week in their diet (4 portions of oily fish/week) Omacor is licensed for secondary prevention post MI for up to 4 years only. Patients should be advised that these products are available to purchase over the counter LOCAL SCLEROSANTS UNLIC Sclerovein injection (0.5%, 1%, 2%) 2.14 OTHER CARDIOVASCULAR DRUGS UNLIC Midodrine tablets (2.5mg) hospital prescribing only KH-KCC Joint formulary Published Version 3 Nov 13 32