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 Formulary Chapter 2: Cardiovascular system - Full Chapter
Notes:

Chapter review date:

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 Details...
02.09  Expand sub section  Antiplatelet drugs
Aspirin
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First Choice
Green
Tablets, suppositories.
  • Enteric coated tablets are non-formulary.

  • Dual antiplatelet therapy in acute coronary syndrome.
  •  
    Clopidogrel
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    Formulary
    Amber

    Tablets.

    • In accordance with NICE recommendations for the use of clopidogrel in the treatment of non-ST-segment-elevation in ACS (TA80), clopidogrel should be used for up to 12 months.

     

    • Post stent insertion (unless follows acute coronary syndrome, see above):
      - clopidogrel should be used for 1 month following insertion of non-drug eluting stent.
      - clopidogrel should be used for 12 months following insertion of a drug-eluting stent.

     

     

    • Update from the Cardiology Working Group July 2017 : The interaction of omeprazole on the antiplatelet efficacy of clopidogrel is no longer considered clinically significant.
     
    Link  In Focus Document - Antiplatelets
    Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
    Link  NICE CG94: unstable angina and NSTEMI
       
    Dipyridamole MR capsules (Persantin® Retard)
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    Formulary
    Amber
    Modified release capsule.
  • Specialist initiation.
  • Use in accordance with NICE TA210.

  •  
    Link  NICE TA210:Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
       
    Ticagrelor (Brilique ®)
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    Formulary
    Amber
    Use in accordance with NICE TA 236 and TA 420.
    GPs should only prescribe in primary care if there is clear direction from the secondary care specialist with regard to indication, dose and duration.


     
    Link  Commissioning statement on the use of Ticagrelor for preventing Atherothrombotic events after myocardial infarction and for the treatment of acute coronary syndromes
    Link  In Focus Document - Antiplatelets
    Link  NICE TA236: Acute coronary syndromes - ticagrelor
    Link  NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction
       
    Prasugrel (Efient ®)
    View adult BNF View SPC online  Track Changes
    Formulary
    Amber
    Tablets.
  • Specialist initiation.
  • Use in accordance with NICE TA 182. In patients with ST elevation and diabetes requiring a stent who are unable to receive treatment with ticagrelor.


  •  
    Link  In Focus Document - Antiplatelets
    Link  MHRA Safety information on hypersensitivity May 2011
    Link  MHRA: increased risk of bleeding—information on timing of loading dose
    Link  NICE TA317 Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes (previously NICE TA182)
       
    Tirofiban (Aggrastat ®)
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    Formulary
    Red
    Injection. 
       
    Abciximab (ReoPro®)
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    Formulary
    Red
    Injection / infusion.
  • Cardiology consultant use only.
  •  
       
    Eptifibatide (Integrilin®)
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    Formulary
    Red
    Injection / infusion.
  • Cardiology consultant use only.
  •  
       
     ....
     Non Formulary Items
    Aspirin (antiplatelet) Enteric Coated

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    Non Formulary
     
    Cangrelor

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    Non Formulary
     
    Dipyridamole (Tablets and Liquid)

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    Non Formulary
     
    Dipyridamole and aspirin M/R capsules  (Asasantin Retard®)

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    Non Formulary Separate constituents are the preferred option. Use in accordance with NICE recommendations for the use of clopidogrel and dypiridamole in vascular disease (TA210).
     
      
    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
    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

    Green

    May be initiated, stabilised and maintained in primary, secondary or tertiary care  

    Amber

    Amber drug - without shared care  

    Amber SCG

    Amber drug - with shared care guideline  

    Red

    For secondary or tertiary care initiation and long-term maintenance of prescribing  

    Black

    Not recommended  

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