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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 2 - Cardiovascular system 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
Links:
Hypertension Resources For Health Professionals NICE guideline NG136 Hypertension in adults: diagnosis and management
02.09 Antiplatelet drugs
NICE CG95: Chest pain of recent onset - March 2010 NICE NG185:Acute coronary syndromes NICE NG1966: Atrial fibrillation: diagnosis and management NICE TA210: Clopidogrel and dipyridamole for prevention of occlusive vascular events - December 2010

Aspirin suppositories

RED
Formulary

150mg & 300mg Suppositories unlicensedunlicensed

BNF BNFc SPC

Tirofiban 250microgram in 1ml (Aggrastat®)
(Concentrate for intravenous infusion)

RED
Restricted Drug Restricted
Restricted - Only to be prescribed under Consultant Cardiologist authorization and in accordance with NICE TA47 which has been partially updated by NICE CG 94 - Unstable angina and NSTEMI: the early management of unstable angina and non-ST-segment-elevation myocardial infarction.

BNF BNFc SPC
NICE TA 47: The use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes

Aspirin tablets

GREEN
Formulary

75mg & 300mg dispersible tablet

 

BNF BNFc SPC

Cangrelor

RED
Formulary

Initiated by cardiology consultant only. 

 

[CG711T clinical guideline approved DTC Sept 2023]

BNF BNFc SPC

Clopidogrel 75mg
(Tablets )

GREEN
Formulary
BNF BNFc SPC
NICE TA80: Acute coronary syndromes - clopidogrel NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events Drug Safety Update: Clopidogrel and proton pump inhibitors: interaction

Prasugrel (Efient®)

Amber SPA
Restricted Drug Restricted
Restricted - Only to be initiated under Cardiology authorization and in accordance with NICE TA182/TA317

5mg & 10mg Film Coated Tablets
BNF BNFc SPC
NICE TA182: Acute coronary syndrome - prasugrel NICE TA317: Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes (review of technology appraisal guidance 182)

Ticagrelor 60mg, 90mg (Brilique®)
(Tablets )

Amber SPA
Formulary

1st line in combination with aspirin in ACS as per trust protocol and NICE TA420.

Strong CYP3A4 inhibitors (e.g. clarithromycin, ketoconazole, itraconazole, voriconazole,nefazodone, ritonavir and atazanavir) interact with ticagrelor and increase its plasma level by up to five times. Please be mindful of drug interactions when prescribing this.

BNF BNFc SPC
NICE TA420: Ticagrelor for preventing atherothrombotic events after MI NICE TAG 236: Ticagrelor for ACS

Ticagrelor 90mg (Brilique®)
(Orodispersible tablets)

Amber SPA
Restricted Drug Restricted

1st line in combination with aspirin in ACS as per trust protocol and NICE TA420.

Orodispersible tablet will dissolve on the tongue for patients with swallowing difficulties or can be dispersed in water to be flushed down a nasogastric tube.

Strong CYP3A4 inhibitors (e.g. clarithromycin, ketoconazole, itraconazole, voriconazole,nefazodone, ritonavir and atazanavir) interact with ticagrelor and increase its plasma level by up to five times. Please be mindful of drug interactions when prescribing this.

BNF BNFc SPC
NICE TA420: Ticagrelor for preventing atherothrombotic events after MI

Dipyridamole

GREEN
Formulary
100mg Tablets
200mg Sustained Release Capsules
50mg in 5mL Suspension
BNF BNFc SPC
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.