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South Staffordshire Joint Formulary
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East Staffordshire Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.09  Expand sub section  Antiplatelet drugs
Aspirin
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Formulary
Green
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).
 
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 EC coated aspirin to reduce GI side effects?
   
Clopidogrel
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Formulary
Green
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.

 
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
   
Cangrelor
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Formulary
Red

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

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

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.

 
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
   
Prasugrel (Efient®)
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Formulary
Amber
Prasugrel Tablet 5mg
Prasugrel Tablet 10mg

 
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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Formulary
Amber
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.

 
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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Restricted Drug Restricted
Red
 
   
Abciximab (Reopro®)
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Restricted Drug Restricted
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
   
Eptifibatide (Integrilin®)
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Restricted Drug Restricted
Red
 
   
 ....
 Non Formulary Items
Aspirin  (Flamasacard®)

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Non Formulary
 
Aspirin (antiplatelet)  (Angettes® 75)

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Non Formulary
 
Aspirin (antiplatelet)  (Caprin®)

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Non Formulary
 
Aspirin (antiplatelet)  (Nu-Seals® Aspirin)

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Non Formulary
 
aspirin and dipyramidole

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Non Formulary combination product no longer available has been discontinued
 
Clopidogrel  (Grepid®)

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Non Formulary
 
Clopidogrel  (Plavix®)

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Non Formulary
  • 75mg and 300mg tablets
  • Prescribe generically
 
Dipyridamole  (Persantin®)

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Non Formulary
 
Dipyridamole  (Persantin® Retard)

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Non Formulary
 
  
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
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Link to adult BNF
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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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