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2. Cardiovascular System

NICE CG172: MI – Secondary Prevention

Other NICE Cardiovascular Guidelines are available via this link 

Digoxin
BNF | BNFC | SPC

Tablets - 62.5microgram, 125microgram, 250microgram 

Elixir - 50microgram/ml 

Bendroflumethiazide
BNF | BNFC | SPC

Tablets - 2.5mg, 5mg 

Indapamide
BNF | BNFC | SPC

Tablets - 2.5mg 

Metolazone
BNF | BNFC | SPC

Tablets - 5mg 

Adjunct in severe heart failure   

Furosemide
BNF | BNFC | SPC

Tablets - 20mg, 40mg, 

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

Amiloride
BNF | BNFC | SPC

Tablets - 5mg 

Oral Solution - 5mg/5ml 

Spironolactone
BNF | BNFC | SPC

Tablets -  25mg, 50mg, 100mg 

Suspension -  5mg/5ml, 10mg/5ml, 25mg/5ml, 50mg/5ml and 100mg/5ml

Prescribe Oral Solution as Rosemont brand 

Hydrochlorothiazide
BNF | BNFC | SPC

Only available in combination with other formulary drugs e.g. co-amilozide

Amiodarone
BNF | BNFC | SPC

Tablets - 100mg, 200mg 

Initiated and titrated to maintenance dose only under specialist supervision

Disopyramide
BNF | BNFC | SPC

Tablets - 100mg, 150mg 

Initiated and titrated to maintenance dose only under specialist supervision

Flecainide
BNF | BNFC | SPC

Tablets- 50mg, 100mg 

MR Capsules - 200mg 

Initiated and titrated to maintenance dose only under specialist supervision

Propafenone
BNF | BNFC | SPC

Tablets - 150mg, 300mg 

Initiated and titrated to maintenance dose only under specialist supervision

Dronedarone
BNF | BNFC | SPC

NICE TA197

400mg tablets

As recommended by NICE approved for patients who are unsuitable for or not tolerant of amiodarone. Treatment is to be initiated by cardiologists. 

Atenolol
BNF | BNFC | SPC

Tablets - 25mg, 50mg, 100mg 

Syrup - 25mg/5ml 

Bisoprolol
BNF | BNFC | SPC

Tablets - 1.25mg, 2.5mg, 3.75mg, 5mg, 7.5mg, 10mg 

Carvedilol
BNF | BNFC | SPC

Tablets - 3.125mg 6.25mg, 12.5mg, 25mg 

Metoprolol
BNF | BNFC | SPC

Tablets - 50mg 

Liquid - 50mg/5ml

Propranolol
BNF | BNFC | SPC

Tablets - 10mg, 40mg, 80mg, 160mg 

Oral Solution - 5mg/5ml, 10mg/5ml, 40mg/5ml, 50mg/5ml 

Sotalol
BNF | BNFC | SPC

Tablets - 40mg, 80mg, 160mg 

Specialist initiation only

Methyldopa
BNF | BNFC | SPC

Tablets - 125mg, 250mg, 500mg 

Doxazosin
BNF | BNFC | SPC

Tablets - 1mg, 2mg, 4mg 

Standard release tablets only not MR

Indoramin
BNF | BNFC | SPC

Tablets - 25mg 

Prazosin
BNF | BNFC | SPC

Tablets - 2mg, 5mg, 10mg 

MHRA Drug Safety Update (June 2014):  Combination use of medicines from different classes of renin-angiotensin system blocking agents: risk of hyperkalaemia, hypotension, and impaired renal function—new warnings

Enalapril
BNF | BNFC | SPC

Tablets - 2.5mg, 5mg, 10mg, 20mg 

Lisinopril
BNF | BNFC | SPC

Tablets - 2.5mg, 5mg, 10mg, 20mg 

Perindopril Erbumine
BNF | BNFC | SPC

Tablets - 2.5mg, 5mg, 10mg 

Perindopril Arginine should not routinely be prescribed on NHS

Ramipril
BNF | BNFC | SPC

Capsules - 1.25, 2.5mg, 5mg, 10mg 

Second line in patients who have tried and were unable to tolerate at least two ACE inhibitors. 

Candesartan
BNF | BNFC | SPC

Tablets - 2mg, 4mg, 8mg, 16mg, 32mg 

For use in Heart failure

Irbesartan
BNF | BNFC | SPC

Tablets - 75mg, 150mg 300mg

For use in patients with Type-2 diabetes

Losartan
BNF | BNFC | SPC

Tablets - 12.5mg, 25mg, 50mg, 100mg 

Oral Suspension - 12.5mg/5ml 

Sacubitril Valsartan
BNF | BNFC | SPC

Tablets - 24mg/26mg, 49mg/57mg, 97mg/103mg

Initiated only in specialist service.

Sacubitril valsartan is recommended as an option for treating symptomatic chronic heart failure with reduced ejection fraction, only in people:

  • With New York Heart Association (NYHA) class II to IV symptoms and
  • With a left ventricular ejection fraction of 35% or less and
  • Who are already taking a stable dose of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor-blockers (ARBs).

Treatment with sacubitril valsartan should be started by a heart failure specialist with access to a multidisciplinary heart failure team.

Glyceryl Trinitrate
BNF | BNFC | SPC

Aerosol Spray - 400micrograms/metered dose 

Isosorbide Mononitrate
BNF | BNFC | SPC

Tablets  - 10mg, 20mg, 40mg 

Amlodipine
BNF | BNFC | SPC

Tablets- 5mg, 10mg 

Verapamil
BNF | BNFC | SPC

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

MR Tablets - 240mg

Oral Solution - 40mg/5ml

 

Diltiazem
BNF | BNFC | SPC

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

Lercanidipine
BNF | BNFC | SPC

Tablets - 10mg, 20mg 

Consultant initiated only

Ivabradine
BNF | BNFC | SPC
Nicorandil
BNF | BNFC | SPC

Tablets - 10mg, 20mg 

Ranolazine
BNF | BNFC | SPC

MR Tablets - 375mg, 500mg, 750mg

3rd line for consultant initiation only

Tinzaparin
BNF | BNFC | SPC

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

MHRA Warning: Risk of serious haemorrhage with dabigatran, rivaroxaban & apixiban

Warfarin
BNF | BNFC | SPC

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

Warfarin tablets disperse in water

Warfarin and Rivaroxaban are First line choices for anticoagulation

Rivaroxaban
BNF | BNFC | SPC

Tablets - 10mg, 15mg 

Warfarin and Rivaroxaban are First line choices for anticoagulation

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

NICE Guidance: NICE TA261, NICE TA256, NICE TA170, NICE TA335

Apixaban
BNF | BNFC | SPC

Tablets - 2.5mg, 5mg 

When Rivaroxaban unsuitable for individual patient following shared decision discussion

NICE TA275

Dabigatran
BNF | BNFC | SPC

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 safety warning: contraindicated in patients with prosthetic heart valve(s) requiring anti-coagulant treatment, because of the risk of thrombosis and haemorrhage

Edoxaban
BNF | BNFC | SPC

Tablets - 15mg 

When Rivaroxaban unsuitable for individual patient following shared decision discussion

NICE CG172: MI – Secondary Prevention

Aspirin
BNF | BNFC | SPC

Tablets - 75mg 

Clopidogrel
BNF | BNFC | SPC

Tablets - 75mg, 300mg 

NICE TA210

MHRA Alert (December 2013): risk of acquired haemophilia with clopidogrel

Prasugrel
BNF | BNFC | SPC

Tablets - 5mg, 10mg 

Specialist initiation only post PCI

Prasugrel: NICE TA317 (review of TA182)

MHRA Alert (January 2014): increased risk of bleeding – advice around timing of loading dose for prasugrel

Ticagrelor
BNF | BNFC | SPC

 

Tablets 60mg, 90mg

  • Specialist Initiation only
  • Only approved for use in accordance with NICE guidance.

Link  NICE TA236: Ticagrelor for the treatment of acute coronary syndromes https://www.nice.org.uk/guidance/ta236?UNLID=20339136120182191458

Link  NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction https://www.nice.org.uk/guidance/ta420?UNLID=20339136120182191458

Guideline for lipid modification in primary and secondary prevention of CVD:

NICE CG172: MI – Secondary Prevention

Simvastatin
BNF | BNFC | SPC

FIRST LINE

Tablets - 10mg, 20mg, 40mg, 80mg 

Tablets May be crushed and administered immediately in water

Atorvastatin
BNF | BNFC | SPC

Tablets - 10mg, 20mg, 40mg, 80mg 

Pravastatin
BNF | BNFC | SPC

Tablets - 10mg, 20mg, 40mg 

Suitable in primary prevention when patient intolerant of simvastatin

Ezetimibe
BNF | BNFC | SPC

Tablets - 10mg 

An option for the treatment of adults with primary hypercholesterolaemia only

Colestyramine (Cholestyramine)
BNF | BNFC | SPC

4g/Sachet

Bezafibrate
BNF | BNFC | SPC

Tablets - 200mg 

Fenofibrate
BNF | BNFC | SPC

Capsules - 200mg