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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
02.10.02 Fibrinolytic drugs
NICE NG128: Stroke and transient ischaemic attack in over 16s: diagnosis and initial management NICE TA52: Myocardial infarction - thrombolysis - October 2002

Alteplase 10mg, 20mg & 50mg (Actilyse®)
(Injection)

RED
Restricted Drug Restricted

Restricted - Only to be prescribed under specialist supervision for PE, MI, post-stroke. Refer to trust guidelines and NICE TA52 and TA264.

Restricted: approved for use by respiratory consultants for severe empyema (unlicensed use) with iintrapleural dornase alfa. See attached protocol for criteria and further details.

BNF BNFc SPC
NICE TA264: Ischaemic stroke (acute) - alteplase NICE TA52: Guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction

Alteplase 2mg Solution for Infusion and Injection (Actilyse Cathflo®)
(Injection/Infusion)

RED
Restricted Drug Restricted

Thrombolytic treatment of occluded central venous access devices 

BNF BNFc SPC
NICE TA264: Ischaemic stroke (acute) - alteplase NICE TA52: Guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction

Streptokinase 1.5 Mega Unit
(Injection)

RED
Formulary
Restricted - Only to be prescribed under specialist supervision for acute STEMI.
BNF BNFc SPC
TA52: Guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction

Tenecteplase (Metalyse®)
(10 000 units (50 mg) powder and solvent for solution for injection)

RED
Restricted Drug Restricted

Restricted - Only to be prescribed under specialist supervision in accordance with NICE TA990

BNF BNFc SPC
NICE TA990: Tenecteplase for treating acute ischaemic stroke

Urokinase

RED
Formulary

10,000 Units & 25,000 Units Injection

For CVC occlusion
Dilute 10 000 units in 2ml 0.9% sodium chloride and follow Trust guidelines (see link).

If unavailable use Taurolock:

Reconstitute Taurolock with the diluent provided (5mL ampoule). Withdraw a 10,000 unit dose (2mL) then follow the procedure on the L&D Trust guideline for a 60 minute dwell time.

Please note, however, that the manufacturer of Taurolock advise that this is not for systemic use and that it should be aspirated once the dwell time is finished.

BNF BNFc SPC
Management of CVC Occlusion
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.