Tablets - 62.5microgram, 125microgram, 250microgram 

Elixir - 50microgram/ml 

Drug Protocol – digoxin loading dose (CDDFT intranet access only)

10mg in 10ml injection

Tablets - 2.5mg, 5mg 

Tablets - 2.5mg 

For indapamide use standard release only (not modified release)

250mg/5ml suspension

Use in paediatrics only

5mg tablets

Unlicensed to be used under the advice of cardiology

Tablets - 20mg, 40mg, 

Oral Solution - 20mg/5ml, 40mg/5ml, 50mg/5ml 

20mg in 2ml, 50mg in 5ml & 250mg in 25ml injections

Drug protocols: (CDDFT intranet access only)

IV Furosemide in the community

IV Furosemide infusion

When given as an infusion rate should not exceed 4mg/min

Single doses of 40-80mg can be given as a slow bolus

1mg & 5mg tablets
1mg in 5ml sugar-free solution
2mg in 4ml injection

Tablets - 5mg 

Oral Solution - 5mg/5ml 

Tablets -  25mg, 50mg, 100mg 

Suspension -  10mg/5ml, 50mg/5ml ^u 

Suspension - 50mg/5ml - Recommended strength in children as per NPPG/RCPCH Position Statement: Using Standardised Strengths of Unlicensed Liquid Medicines in Children.

Prescribe Oral Solution as Rosemont brand 

Notes: post-acute myocardial infarction patients and patients with heart failure treatment should be initiated on instructions from a cardiologist or GP with a specialist interest in cardiology.  Spironolactone is first choice (ahead of eplerenone) for severe heart failure.

MHRA Drug Safety Update (Feb 2016): Spironolactone and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia

MHRA Drug Safety Update (Dec 2016): Spironolactone and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia—clarification, December 2016

Please set up recall for potassium monitoring on initiation, as per South Tees HFT Cardiology guidelines

25mg & 50mg tablets

Indication: to reduce the risk of cardiovascular mortality and morbidity in stable patients with left ventricular dysfunction and clinical evidence of heart failure after myocardial infarction, usually initiated on day 4 or 5 post-acute MI.
Notes: Eplerenone may have a place in those patients unable to tolerate spironolactone (due to gynaecomastia or nausea).
Restrictions: treatment should only be initiated on instructions from a consultant cardiologist or a GP with a specialist interest in cardiology.

Please set up recall for potassium monitoring on initiation, as per South Tees HFT Cardiology guidelines

Tees Do Not Prescribe/Grey List

10% & 20% intravenous infusions

For raised intra-ocular pressure or cerebral oedema

300mg in 20ml injection

Tablets - 25mg 

Hydralazine restriction: usually hospital initiation

5mg & 10mg tablets

For hypertension. All other indications considered RED drug.
Treatment should only be on the advice of a cardiologist/ nephrologist.

Red drug for Raynaud's (Unlicensed indication)

Tablets - 25mg and 50mg 

MHRA Drug Safety Update (Nov 2018): Sildenafil (Revatio and Viagra): reports of persistent pulmonary hypertension of the newborn (PPHN) following in-utero exposure in a clinical trial on intrauterine growth restriction

Tablets - 125mg, 250mg, 500mg 

200, 300 & 400 microgram tablets

100 microgram tablets

Tablets - 1mg, 2mg, 4mg 

Standard release tablets only not MR

10mg capsules; 100mg in 2ml injection

Use in Phaeochromocytoma only

10mg in 1ml injection

24mg/26mg, 49mg/51mg & 97mg/103mg tablets

NICE TA388

See  CD&D Place in therapy for Sacubitril valsartan in both newly diagnosed and existing heart failure

Tees Sacubitril Valsartan Prescribing Guidance

62.5mg & 125mg tablets

NHS England – Not Routinely Commissioned for digital ulcers

Commissioner: NHS England - Policy - A11/P/a & A11/PS/b

10mg tablets

Commissioner: NHS England - Policy - A11/P/a & A11/PS/b

20mg tablets (Revatio®)
25mg, 50mg and 100mg tablets ^u

Commissioner: NHS England - Policy - A11/P/a & A11/PS/b

MHRA Drug Safety Update (Nov 2018): Sildenafil (Revatio and Viagra): reports of persistent pulmonary hypertension of the newborn (PPHN) following in-utero exposure in a clinical trial on intrauterine growth restriction

50 microgram in 0.5ml & 100 microgram in 1ml inj ^u
10 microgram in 1ml and 20 microgram in 2ml nebules

Commissioner: NHS England - Policy - A11/PS/b

Aerosol Spray - 400micrograms/metered dose 

Tablets  - 10mg, 20mg, 40mg 

Dosage form restriction: avoid using modified release or patch preparations. Standard release isosorbide mononitrate should be prescribed using twice daily asymmetric dosing (e.g. 8am & 4pm)

5mg in 5ml , 50mg in 10ml & 50mg in 50ml injections

Glyceryl Trinitrate IV Infusion: CDDFT Drug Protocol

IV should be given using polyethylene giving set not PVC

Tablets- 5mg, 10mg 

Notes: if a 10mg dose is not tolerated e.g. due to leg/ankle oedema, consider reducing dose before changing to an alternative such as lercanidipine

Hypertension Guidelines (based upon NICE CG127) Primary Care Website

MR Tablets - 60mg 

MR Tablets/Capsules (BD preparations) - 90mg, 120mg, 180mg

MR Tablets/Capsules (OD preparations) - 120mg, 180mg, 240mg, 300mg, 360mg.

Different versions of modified release diltiazem containing more than 60mg may not have the same clinical effect. Specify brand to avoid confusion

Brand – Viazem XL is the Formulary brand of choice for starting new patients on long acting diltiazem

2.5mg, 5mg and 10mg MT tablets

Tablets - 10mg, 20mg 

Indication: for use as a 2nd line calcium channel blocker where amlodipine is not tolerated

Once Daily formulations (Preferred)
20mg controlled release tablets (Adalat LA), 30mg &
60mg m/r capsules (Coracten XL)
Other Formulations
5mg & 10mg capsules
10mg & 20mg retard tablets
20mg per ml (1mg/drop) drops^u

Nifedipine Modified Release Brand: Coracten XL is the once daily brand of choice

30mg tablets 

Nimodipine indication: only for the prevention of vascular spasm following subarachnoid haemorrhage

10mg in 50ml (200 micrograms/ml) for IV infusion

Nimodipine indication: only for the prevention of vascular spasm following subarachnoid haemorrhage

Tablets - 40mg, 80mg, 120mg, 160mg

MR Tablets - 240mg

Oral Solution - 40mg/5ml

Verapamil indication: arrhythmias or angina

Tablets - 10mg, 20mg 

MHRA Drug Safety Update (Jan 2016): Nicorandil (Ikorel): now second-line treatment for angina - risk of ulcer complications

Tablets - 5mg, 7.5mg  

Indication: for symptomatic treatment of chronic stable angina pectoris in patients with normal sinus rhythm for whom heart rate control is desirable and who have a contra-indication or intolerance for beta-blockers and rate-limiting calcium-channel blockers.

Restrictions: for initiation on advice from consultant cardiologists in patients with contra-indications to or intolerance of standard therapy

MHRA Drug Safety Update (Dec 2014): Ivabradine (Procoralan) in the symptomatic treatment of angina: risk of cardiac side effects

Approved for use in accordance with the following NICE TAs:

• NICE TA267: Ivabradine for treating chronic heart failure

375mg, 500mg and 750mg prolonged release tablets.

Indication: the treatment of angina which cannot be treated satisfactorily using standard antianginal drugs and / or revascularisation.

100mg capsules

In Raynaud’s phenomenon some patients may require treatment with a vasodilator. Nifedipine may be of use, especially in primary Raynaud’s syndrome.

NICE TA223

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

250mg in 20ml injection
250mg in 50ml injection

Dobutamine: CDDFT Drug Protocol

200mg in 5ml injection

Dopamine: CDDFT Drug Protocol

50mg in 5ml injection

100 microgram in 2ml injection, 2mg in 2ml injection^u

Isoprenaline: CDDFT Drug Protocols

2mg in 2ml & 4mg in 4ml (1 in 1,000) injections

See Letter Sent to Healthcare Professionals (March 2016): Noradrenaline (Norepinephrine) 0.08 mg/ml (4 mg in 50 mil solution for infusion in a vial with potential risk of medication errors

30mg in 1ml injection

10mg in 1ml injection^u

10mg in 1ml injection & 3000mcg in 30ml syringe

2.5mg & 5mg tablets

For limited specialist use in treating symptomatic hypotension that has not responded to conventional therapies.

1 in 1,000 injections in 1ml syringes and 1ml & 10ml ampoules
1 in 10,000 injections in 1ml & 10ml ampoules & syringes

To be prescribed by brand name to prevent prescribing/dispensing errors.

Clexane Brand

2,000 IU (20 mg)/0.2 ml solution for injection in pre-filled syringe
4,000 IU (40 mg)/0.4 ml solution for injection in pre-filled syringe
6,000 IU (60 mg)/0.6 ml solution for injection in pre-filled syringe
8,000 IU (80 mg)/0.8 ml solution for injection in pre-filled syringe
10,000 IU (100 mg)/1 ml solution for injection in pre-filled syringe

12,000 IU (120 mg)/0.8 ml solution for injection in pre-filled syringe
15,000 IU (150 mg)/1 ml solution for injection in [pre-filled syringe

Inhixa Brand▼

20mg/0.2mll solution for injection in pre-filled syringe

40mg/0.4mlsolution for injection in pre-filled syringe
60mg/0.6ml solution for injection in pre-filled syringe
80mg/0.8ml solution for injection in pre-filled syringe
100mg/ml solution for injection in pre-filled syringe 

Arovi Brand (formerly Enoxaparin Becat)▼

20mg/0.2ml solution for injection in pre-filled syringe
40mg/0.4mlsolution for injection in pre-filled syringe
60mg/0.6ml solution for injection in pre-filled syringe
80mg/0.8ml solution for injection in pre-filled syringe
100mg/ml solution for injection in pre-filled syringe
120mg/0.8ml solution for injection in pre-filled syringe
150mg/ml solution for injection in pre-filled syringe

See Letter Sent to Healthcare Professionals (June 2017) - Clexane (enoxaparin sodium): updates to strength expression, dose regimens in DVT/PE, use in patients with severe renal impairment

50 units in 5ml & 200 units in 2ml – for flushing cannulae

Drug protocol: heparin in general medicine (CDDFT intranet access only)

Drug protocol: Unfractionated Heparin (treatment dose) for use in Vascular Surgery (CDDFT intranet access only)

1.5mg in 0.3ml injection, 2.5mg in 0.5ml injection,
5mg in 0.4ml injection, 7.5mg in 0.6ml injection &
10mg in 0.8ml injection in pre-filled syringes

Fondaparinux indication: for the treatment of unstable angina or non ST-elevation myocardial infarction.  CDDFT Drug Protocol

750 units in 0.6ml injection (1,250 units/ml)

Danaparoid notes: for use on specific advice from haematologists in patients who develop thrombocytopaenia with heparins - cross reactivity with heparin antibodies is probably <10%

Epoprostenol (as sodium salt) 500 microgram & 1.5mg injection injection (Folan®)

Epoprostenol (as sodium) 500 microgram & 1.5mg injection injection (Veletri®)

CAUTION TWO BRANDS AVAILABLE

Epoprostenol PVD CDDFT Drug Protocol

Commissioner: NHS England - Policy - A11/PS/b

See Letter Sent to Healthcare Professionals (Sept 2016):

Flolan® (epoprostenol) – Introduction of new sterile solvent with different pH; temporary availability of two different formulations.

See Letter Sent to Healthcare Professionals (April 2017) - Floran (epoprostenol): reminder of replacement of Flolan (with Solvent pH 10.5) with Flolan (with Solvent pH 12)

50 microgram in 0.5ml & 100 microgram in 1ml injections^u

Unlicensed

10,000units/ml as 2500unit, 3500unit, 4500unit, 20,000unit Syringes

N.B. In Tees is AMBER SHARED CARE when used in obstetrics for Prophylaxis for Venous Thromboembolism (VTE) in ante- and post-natal women (high risk) pregnancy BUT ONLY if patient is to be seen/follow-up in primary care by a non-prescriber.

250 mg powder for concentrate for solution for injection or infusion

Approved: NICE TA230

1 mg/ml Solution for Infusion.

Heparin induced thrombocytopenia on specialist advice only

Tablets - 500micrograms(white), 1mg (brown), 3mg(blue), 5mg(pink) 

Warfarin and Rivaroxaban are First line choices for anticoagulation

CDDFT Intranet Oral anticoagulation with warfarin - adult patient management guidelines (including bleeding with NOACs)

Tees Warfarin Guidelines for Primary Care

MHRA Drug Safety Update (July 2016): Warfarin: reports of calciphylaxis

Tablets - 2.5mg, 10mg, 15mg, 20mg 

Warfarin and Rivaroxaban are First line choices for anticoagulation

MHRA Drug Safety Update (Oct 2013): Risk of serious haemorrhage with dabigatran, rivaroxaban & apixiban

MHRA Drug Safety Update (Oct 2018): Rivaroxaban (Xarelto▼) after transcatheter aortic valve replacement: increase in all-cause mortality, thromboembolic and bleeding events in a clinical trial

MHRA Drug Safety Update (July 2019): Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken with food

MHRA Drug Safety Update (Jun 2019): Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome

Indication: in the treatment of AF and DVT where patients can’t tolerate other treatment options and also in the fast track DVT pathway

Approved for use in accordance with the following NICE TAs

• NICE TA170:Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults
• NICE TA261:Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
• NICE TA256:Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
• NICE TA287:Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism
• NICE TA335:Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome

Tablets - 2.5mg, 5mg 

When Rivaroxaban unsuitable for individual patient following shared decision discussion

Approved for use in accordance with the following NICE TAs

• NICE TA245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults
• NICE TA275: Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation
• NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism

MHRA Drug Safety Update (Jun 2019): Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome

Tablets - 75mg, 110mg and 150mg 

When Rivaroxaban unsuitable for individual patient following shared decision discussion

Approved indication: for prevention of stroke in non-valvular atrial fibrillation

NICE Guidance: NICE TA249, NICE TA157, NICE TA327

MHRA Drug Safety Update (March 2013): Dabigatran - contraindicated in patients with prosthetic heart valve(s) requiring anti-coagulant treatment, because of the risk of thrombosis and haemorrhage

MHRA Drug Safety Update (Oct 2013): Risk of serious haemorrhage with dabigatran, rivaroxaban & apixiban

MHRA Drug Safety Update (Jun 2019): Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome

Tablets - 15mg, 30mg, 60mg 

When Rivaroxaban unsuitable for individual patient following shared decision discussion

Approved for use in accordance with the following NICE TAs:

• NICE TA355: Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation
• NICE TA354: Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism

MHRA Drug Safety Update (Jun 2019): Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome

10mg and 25mg tablets

For use in patients intolerant of warfarin

1mg tablets

For use in patients intolerant of warfarin

2.5mg tablets

Rivaroxaban co-administered with acetylsalicylic acid (ASA), is indicated for the prevention of atherothrombotic events in adult patients with coronary artery disease (CAD) or symptomatic peripheral artery disease (PAD) at high risk of ischaemic events.

Approved for use in accordance with the following NICE TAs:

• NICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease

50mg in 5ml injection

2.5g/50ml solution for injection/infusion

200mg powder for solution for infusion

NTAG September 2019:  The Northern (NHS) Treatment Advisory Group does not currently recommend the use of andexanet alfa (Ondexxya®) for use in adult patients treated with a direct factor Xa (FXa) inhibitor (apixaban or rivaroxaban) when reversal of anticoagulation is needed due to lifethreatening or uncontrolled bleeding.

Prothrombin complex concentrate

For use in reversing the effects of oral anticoagulants in patients with life or limb threatening bleeding in accordance with a regional protocol – see CDDFT Intranet Oral anticoagulation with warfarin - adult patient management guidelines (including bleeding with NOACs)

Commissioner: NHS England - BCSH Guidelines

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

Tablets - 10mg, 20mg, 40mg, 80mg 

Tablets - 10mg, 20mg, 40mg, 80mg 

Tablets May be crushed and administered immediately in water

Tablets - 10mg, 20mg, 40mg 

5mg, 10mg, 20mg & 40mg tablets

CD&D APC Grey List: Only to be considered as an option when patient has proven intolerance to, or lack of desired result from simvastatin, pravastatin and atorvastatin and in accordance with County Durham and Darlington PCTs Lipid Modification Guidelines OR as per FATS Guidelines.

10mg and 20mg chewable tablets

More cost effective than simvastatin or atorvastatin liquid. For use in patients with swallowing difficulties needed a statin. 

Tablets - 10mg 

Ezetimibe restrictions: see guideline

NICE guidance: NICE TA385

FATS7 Strategy for the Use of Cholesterol Lowering Drugs Primary Care Website

CDDFT Intranet

4g/Sachet

625mg tablets

RED if for use in patients who develop diarrhoea whilst taking lenalidomide 

67mg, 200mg & 267mg capsules

MHRA Drug Safety Update (Feb 2019):  Fibrates: first-line treatment not recommended

Tablets - 200mg 

The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or 
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/

See also NICE CG172 “do not do recommendation”

The product is being withdrawn throughout the EU after a study has shown a failure to reduce major vascular events and an increase in non-fatal serious adverse events

75mg/1ml & 150mg/1ml solution for injection in prefilled pen

NICE TA393

See also NTAG recommendation

140mg/1ml solution for injection in pre-filled syringe

NICE TA394

See also NTAG recommendation