South Staffordshire Joint Formulary Formulary


	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

Antiplatelet drugs

Aspirin

Formulary

Aspirin Dispersible Tablet 75mg

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).

British and Irish Hypertension Society Statement - Use of Aspirin in Primary CVD Prevention

UKMI Q&A (SPS): Is there evidence to support the use of EC coated aspirin to reduce GI side effects?

Clopidogrel

Formulary

Clopidogrel Tablet 75mg

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.

NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events

MHRA Drug Safety Update: Clopidogrel and proton pump inhibitors: interaction—updated advice

MHRA Drug Safety Update: Clopidogrel: risk of acquired haemophilia

Cangrelor

Formulary

Not Recommended by NICE for reducing atherothrombotic events in people undergoing percutaneous coronary intervention or awaiting surgery requiring interruption of anti-platlet therapy

NICE TA351 : Cangrelor for reducing atherothrombotic events in people undergoing percutaneous coronary intervention or awaiting surgery requiring interruption of anti-platelet therapy (terminatedappraisal)

Dipyridamole

Formulary

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

NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events

Prasugrel (Efient^®)

Formulary

Prasugrel Tablet 5mg
Prasugrel Tablet 10mg

NICE TA317: Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes

MHRA Drug Safety Update: Prasugrel (Efient): increased risk of bleeding

Ticagrelor (Brilique^®)

Formulary

Ticagrelor Tablet 90mg

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

NICE TA236: Ticagrelor for the treatment of acute coronary syndromes

NICE TA420:Ticagrelor for preventing atherothrombotic ardial infarction

Tirofiban (Aggrastat^®)

Restricted

Abciximab (Reopro^®)

Restricted

DISCONTINUED

NICE TA47: Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes

ReoPro: Indefinate supply shortage

Eptifibatide (Integrilin^®)

Restricted

NICE CG172: MI - Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease

NICE CG180: Atrial fibrillation: management

NICE CG94: Unstable angina and NSTEMI: early management

NICE CG95: Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis

NICE NG106: Chronic heart failure in adults: diagnosis and management

NICE TA210: Clopidogrel and dipyridamole for prevention of occlusive vascular events

....

Non Formulary Items

Aspirin (Flamasacard^®)

Non Formulary

Aspirin (antiplatelet) (Angettes^® 75)

Non Formulary

Aspirin (antiplatelet) (Caprin^®)

Non Formulary

Aspirin (antiplatelet) (Nu-Seals^® Aspirin)

Non Formulary

aspirin and dipyramidole

Non Formulary

combination product no longer available has been discontinued

Clopidogrel (Grepid^®)

Non Formulary

Clopidogrel (Plavix^®)

Non Formulary

75mg and 300mg tablets
Prescribe generically

Dipyridamole (Persantin^®)

Non Formulary

Dipyridamole (Persantin^® Retard)

Non Formulary

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	Drugs which require special consideration. These are drugs for Consultant Prescribing ONLY. They should not be prescribed in Primary Care.
	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.
	Drugs that should be initiated by a Specialist but are suitable for continuation in Primary Care but also require and ESCA (Shared Care Agreement)
	Suitable first-line drugs for implementation in Primary Care
	South Staffs Formulary Choice