NICE CG172: MI – Secondary Prevention
Other NICE Cardiovascular Guidelines are available via this link
Tablets - 100mg, 200mg
Initiated and titrated to maintenance dose only under specialist supervision
Tablets - 100mg, 150mg
Initiated and titrated to maintenance dose only under specialist supervision
Tablets- 50mg, 100mg
MR Capsules - 200mg
Initiated and titrated to maintenance dose only under specialist supervision
Tablets - 150mg, 300mg
Initiated and titrated to maintenance dose only under specialist supervision
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.
Tablets - 10mg, 40mg, 80mg, 160mg
Oral Solution - 5mg/5ml, 10mg/5ml, 40mg/5ml, 50mg/5ml
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
Tablets - 2.5mg, 5mg, 10mg
Perindopril Arginine should not routinely be prescribed on NHS
Second line in patients who have tried and were unable to tolerate at least two ACE inhibitors.
Tablets - 75mg, 150mg 300mg
For use in patients with Type-2 diabetes
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:
Treatment with sacubitril valsartan should be started by a heart failure specialist with access to a multidisciplinary heart failure team.
Tablets - 40mg, 80mg, 120mg, 160mg
MR Tablets - 240mg
Oral Solution - 40mg/5ml
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
Tablets - 5mg, 7.5mg
Consultant cardiologist initiation only
MHRA Warning: Risk of serious haemorrhage with dabigatran, rivaroxaban & apixiban
Tablets - 500micrograms(white), 1mg (brown), 3mg(blue), 5mg(pink)
Warfarin tablets disperse in water
Warfarin and Rivaroxaban are First line choices for anticoagulation
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
Tablets - 2.5mg, 5mg
When Rivaroxaban unsuitable for individual patient following shared decision discussion
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
NICE CG172: MI – Secondary Prevention
Tablets - 75mg, 300mg
MHRA Alert (December 2013): risk of acquired haemophilia with clopidogrel
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
Tablets 60mg, 90mg
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
FIRST LINE
Tablets - 10mg, 20mg, 40mg, 80mg
Tablets May be crushed and administered immediately in water
Tablets - 10mg, 20mg, 40mg
Suitable in primary prevention when patient intolerant of simvastatin
Tablets - 10mg
An option for the treatment of adults with primary hypercholesterolaemia only