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1 Chapter 2- Cardiovascular Category Drug name Strength / dose / form BCU 2.1 Positive Inotropic drugs Cardiac Digoxin 62.5 microgram Tablets Glycosides 125 microgram Tablets 250 microgram Tablets 500 microgram/2ml Injection 100 microgram/1ml Injection 50 micrograms/1ml 2.2 Diuretics Thiazides and related diuretics Loop Diuretics Potassiumsparing diuretics and aldosterone antagonists Digoxin specific antibody fragments (Digibind) Elixir 38mg vials Bendroflumethiazide 2. Metolazone Furosemide Bumetanide Amiloride Spironolactone Eplerenone Comments Special (paeds) Unlicensed Stock and guidance to be available on each acute hospital site 20mg Tablets 500mg Tablets 40mg/5mL Liquid SF, standardise strength 50mg/5mL Injection Less risk and more cost effective to use this than 2 x 20mg amps 250mg/25mL injection Renal use 1mg Tablets 2mg/4mL Injection 1mg/5mL Liquid For those with swallowing difficulties 5mg/5mL Liquid 2 50mg/5mL Suspension Special standardise strength 2 Hospital initiation only. Approved for use in EAST, West & Central. In use in 2 areas.

2 Category Drug name Strength / dose / form BCU Comments Potassiumsparing Co-amilofruse (amiloride + hydrochlorothiazide) 2.5/20 diuretics with other diuretics 5/ Osmotic Mannitol 10% 500mL Infusion diuretics 20% 500mL Infusion 2.3 Anti-arrhythmic drugs Drugs for Adenosine 6mg/2mL Injection arrhythmias 30mg/10mL injection usually initiated Amiodarone Initiation by cardiology team only in hospital 200mg Tablets Initiation by cardiology team only 150mg/3mL Injection 300mg in 10mL pre-filled Cardiac arrest boxes only. syringe Dronedarone 400mg tablets As per NICE started by or recommendation of cardiologist with a review of effect at 3 months Propafenone 1 300mg Tablets Disopyramide Flecainide 50mg/5mL Injection 150mg/15mL Injection Magnesium sulphate 2.4 Beta Blockers Propranolol Atenolol 25mg/5mL liquid 80mmol (20g) in 250mL sodium chloride 0.9% bags 20mmol (5g) in 10mL ampoules 50% Special. Currently only available in Central as a pre-prepared bag. Explore availability in East & West Anxiety tachycardias & thyrotoxicosis 80mg Tablets Inj 1mg/1mL for neuroleptic malignant syndrome 2

3 Category Drug name Strength / dose / form BCU 25mg/5mL Syrup Bisoprolol fumarate 1.25mg Tablet 2.5mg Tablet 3.75mg Tablet 5mg Tablet 7.5mg tablet 10mg Tablet Carvedilol mg Tablet 6.25mg Tablet 12.5mg Tablet 25mg Tablet Esmolol hydrochloride Inj 10mg/mL 250mL infusion bag Labetalol 200mg Tablets 400mg Tablets 100mg/20mL Injection Metoprolol 5mg/5mL Injection Sotalol 80mg Tablets 160mg Tablets 2.5 Hypertension and Heart failure Hydralazine 2 Vasodilator 20mg Injection antihypertensiv Minoxidil 2. e drugs 10mg tablets Centrally Clonidine 25microgram Tablets acting 100microgram Tablets antihypertensiv 150microgram in 1 ml Inj es Methyldopa 12 Comments Special 2.5g/250mL less suitable for prescribing ITU use

4 Category Drug name Strength / dose / form BCU Comments Alpha Doxazosin 2 500mg Tablets 1mg Tablets XL presentations non Blockers 2mg Tablets 4mg Tablets Phenoxybenzamine 10mg capsules Oral treatment for phaeos Phentolamine 10mg/mL Injection Choice for Phaeos Drugs affecting the rennin-angiotensin system Enalapril Angiotensin converting enzyme inhibitors Angiotensin II receptor antagonists Lisinopril Ramipril Candesartan Irbesartan Losartan potassium olmesartan 2. 20mg tablets 2. 20mg Tablets 1.25mg Capsules 2.5mg Capsules 5mg Capsules 10mg Capsules 2mg Tablets 4mg Tablets 8mg Tablets 16mg Tablets 32mg Tablets mg Tablets 2 10mg tablets 20mg tablets 40mg tablets Not for initiation Specialist use only to be reserved for patients with resistant hypertension already taking 4 other hypertensives including an angiotensin-ii receptor antagonist.

5 Category Drug name Strength / dose / form BCU 2.6 Nitrates, calcium-channel blockers, and other antianginal drugs Nitrates Glyceryl Trinitrate Sublingual Spray 400 micrograms 5mg Transdermal patch 10mg Transdermal patch 50mg/50mL Infusion Isosorbide Mononitrate 20mg tablets Calciumchannel Amlodipine blockers Diltiazem 60mg Tablets 90mg MR tablets 120mg MR Tablets 180mg MR Tablets 240mg MR Tablets 200mg MR Tablets 300mg MR Tablets 360mg MR Tablets 90mg MR Capsules 120mg MR Capsules 180mg MR Capsules 200mg MR Capsules 240mg MR Capsules 300mg MR Capsules Nifedipine 10mg MR Tablets 20mg MR Tablets 30mg MR Tablets 60mg MR Tablets Nimodipine 30mg Tablets 200microgram/mL Infusion 50mL Verapamil 120mg MR Tablets 240mg MR Tablets 120mg MR Capsules Comments Preferred presentation Preferred for initiation Use asymmetric dosage regime Tildiem LA 200mg only product on DT for diltiazem tabs 200mg. CEG group to advise on brand recommended Prescribe by brand Following sub arachnoid haemorrhage Very difficult to recommend one brand as Univer 120mg is much cheaper than half-securon 120mg and Securon 240mg is much cheaper than Univer 240mg.

6 Category Drug name Strength / dose / form BCU 180mg MR Capsules 240mg MR Capsules 5mg/2mL Injection Other Ivabradine antianginal 7. drugs Nicorandil 20mg Tablets 2.7 Sympathomimetics Inotropic sympathomime tics Vasoconstricto r sympathomime tics Cardiopulmona ry resuscitation Comments Hospital initiation only Dobutamine 250mg/5mL Injection LVF. Infusion table Dopamine 200mg/5mL Injection Infusion table Dopexamine 50mg/5mL injection isoprenaline 2mg in 2mL special Ephedrine hydrochloride 30mg/mL Injection Metaraminol 10mg/mL Injection Special. Noradrenaline / 1mg/mL (base) 4mL Norepinephrine Injection 8mg/50mL injection ITU use - avoids multiple manipulations NPSA alert (special) Phenylephrine 10mg/mL injection Adrenaline/Epinephrine 1 in 1000 (1mg/mL) 2.8 Anticoagulants and Protamine Parenteral Heparin (Unfractionated) Anticoagulants Enoxaparin Injection 1mL 1 in 10,000 (100microgram/mL) Injection 10mL Cardiac arrest 10 units/ml Injection Paed line flushes 100 units/ml Injection 2mL for flushing central lines 1,000 units/ml Injection 25,000 units/50ml syringe Special prepared ready to use syringe by SPU Central 20mg Pre filled syringe DVT & PE, Unstable angina / Non STEMI 40mg Pre filled syringe 60mg Pre filled syringe 80mg Pre filled syringe 100mg Pre filled syringe 120mg Pre filled syringe 150mg Pre filled syringe

7 Category Drug name Strength / dose / form BCU Comments 300mg in 3mL vial Cath Lab only. Only purchased at other times of PFS shortage Tinzaparin 2,500units PFS LMWH for haemodialysis and haemofiltration only. 3,500 units PFS 4,500 units PFS Epoprostenol 500microgram Infusion Oral Warfarin 0. anticoagulants (500micrograms) 1mg Tablets 3mg Tablets Acenocoumarol / 1mg Tablets Haematology only. Preferred alternative to warfarin Nicoumalone Protamine Protamine 50mg/5ml Injection 2.9 Antiplatelet Aspirin 75mg Soluble Tablets East to work on reducing amount of EC used Drugs 300mg Soluble Tablets Clopidogrel 7 300mg Tablets prasugrel 10mg tablets Hospital initiation only as per NICE guidance Dipyridamole 200mg SR Capsules For those unable to take clopidogrel Dipyridamole with Aspirin Aspirin 25mg + Dipyridamole (M/R) 200mg Asasantin Retard Less expensive then plain MR dipyridamole (DT Jan 2011) eptifibatide 20mg/10mL injection CCU & Cath lab only. Only used in Central 75mg/100mL infusion Tirofiban 250microgram/mL 50mL Concentrate for infusion Used in East & West Abciximab 10mg in 5mL Used in Cath Lab central 2.10 Stable angina, acute coronary syndromes, and fibrinolysis Alteplase 10mg infusion 20mg Infusion Fibrinolytic Drugs 50mg Infusion Tenectaplase 50mg Injection (10,000 units) Urokinase 25,000 units Injection 100, 000 units injection 2.11 Antifibrinolytics & Haemostatics Tranexamic Acid 500mg tablets Disperse tablets or even use injection if liquid needed. 500mg/5mL Injection

8 Category Drug name Strength / dose / form BCU Comments Blood Products Drotrecogin Alpha (Activated) 5mg Infusion 20mg As per NICE guidance. ITU Only 2.12 Lipid-regulating drugs Statins Simvastatin 20mg Tablets 20mg is an option in the NW Cardiac Network statin guidance for those intolerant to 40mg simvastatin 80mg Tablets In hospital cheaper to double up with 2 x 40mg on welsh contract 80mg is an option in the NW Cardiac Network statin guidance Atorvastatin 80mg Tablets ACS for 3 months then review Pravastatin For those patients on drugs that interact with other statins 40mg is an option in the NW Cardiac Network statin guidance for those intolerant to 40mg simvastatin Bile Acid Colestyramine 4g Sachets Interferes with absorption of other drugs. Sequestrants Ezetimibe As per NICE guidance although evidence now suggests may not be effective Fibrates Fenofibrate 160mg tablets Better triglycerides lowering than statins particularly for diabetics and renal patients Fibrate recommended by NW Cardiac Network. Most cost effective preparation

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