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South Staffordshire Joint Formulary
Cannock Chase Clinical Commissioning Group
East Staffordshire Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.09  Expand sub section  Antiplatelet drugs
Aspirin (AcetylsalicylicAcid)
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Green

Aspirin Dispersible 75mg Tablet


Use of low dose aspirin for the primary prevention of heart attacks and strokes in people without cardiovascular disease including diabetic patients is no longer recommended as the increased risk of bleeding outweighs any vascular benefits.

Prescribing of antiplatelets for secondary prevention should be in line with NICE Guidelines.

Patients with mild to moderate dyspeptic symptoms taking aspirin should be prescribed a PPI or H2 antagonist before switching to clopidogrel (which may also cause gastro-intestinal adverse effects).

 
Link  British and Irish Hypertension Society Statement - Use of Aspirin in Primary CVD Prevention
Link  UKMI Q&A (SPS): Is there Evidence to Support the use of Enteric Coated (EC) Aspirin to Reduce Gastrointestinal Side Effects in Patients with Cardiovascular Disease?
   
Clopidogrel
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Green

Clopidogrel 75mg Tablet

The MHRA has updated its advice on the interaction between PPI's and clopidogrel. It now recommends that use of either omeprazole or esomeprazole with clopidogrel should be discouraged. This does not include lansoprazole.

 
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
Link  MHRA Drug Safety Update: Clopidogrel and proton pump inhibitors: interaction—updated advice
Link  MHRA Drug Safety Update: Clopidogrel: risk of acquired haemophilia
   
Dipyridamole
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Green

Dipyridamole M/R 200mg Capsule
Dipyridamole 50mg/5ml Oral Suspension SF 


There is a difference in indication between the modified-release preparation of dipyridamole and the standard-release tablets and liquid.

National recommendations for secondary prevention of occlusive vascular events recommend the use of modified-release dipyridamole, according to the licensed indications.

 
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
   
Eptifibatide (Integrilin®)
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Red
Eptifibatide 20mg/10ml solution for injection vials
Eptifibatide 75mg/100ml solution for infusion vials
 
   
Prasugrel (Efient®)
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Amber

Prasugrel 5mg Tablet
Prasugrel 10mg Tablet

 
Link  NICE TA317: Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes
Link  MHRA Drug Safety Update: Prasugrel (Efient): increased risk of bleeding
   
Ticagrelor (Brilique®)
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Amber

Ticagrelor 60mg Tablet
Ticagrelor 90mg Tablet
Ticagrelor Orodispersible 90mg Tablet

Restriction: In line with NICE Guidance only


Ticagrelor can now be used up to a maximum of 3 years as per NICE TA420.
Duration needs to be specified by initiating specialist.

 
Link  NICE TA236: Ticagrelor for the treatment of acute coronary syndromes
Link  NICE TA420:Ticagrelor for preventing atherothrombotic ardial infarction
   
Tirofiban (Aggrastat®)
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Red
Tirofiban 12.5mg/250ml infusion bags
Aggrastat®12.5mg/50ml concentrate for solution for infusion vials
 
   
Abciximab (Reopro®)
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Red

   DISCONTINUED

 
Link  NICE TA47: Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes
Link  ReoPro: Indefinate supply shortage
   
 link Link    NICE CG95: Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis
 link Link    NICE NG106: Chronic heart failure in adults: diagnosis and management
 link Link    NICE NG185: Acute coronary syndromes
 link Link    NICE NG196: Atrial fibrillation: diagnosis and management
 link Link    NICE TA210: Clopidogrel and dipyridamole for prevention of occlusive vascular events
 ....
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

Red

 Drugs which require special consideration. These are drugs for Consultant Prescribing ONLY. They should not be prescribed in Primary Care.  

Amber

 Drugs that should be initiated by a Specialist but are suitable for continuation in Primary Care. For some drugs there may be a Ricad in place to aid the transition to primary care.  

Amber E

 Drugs that should be initiated by a Specialist but are suitable for continuation in Primary Care but also require and ESCA (Shared Care Agreement)   

Green

 Suitable first-line drugs for implementation in Primary Care  

On Formulary

 South Staffs Formulary Choice  

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