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NHS Trust Formulary  
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.08.01  Expand sub section  Parenteral anticoagulants
02.08.01  Expand sub section  Heparin
Heparin
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Formulary Injection

 
   
02.08.01  Expand sub section  Low molecular weight heparins
 note  For details of GMMMG RAG list status for the Low Molecular Weight Heparins, see: http://gmmmg.nhs.uk/html/rag_adult.php
Enoxaparin
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First Choice
Green
Subcutaneous injection

Green Traffic Light Green2 or Green3 depending on indication. See GMMMG RAG list for full details 
02.08.01  Expand sub section  Heparinoids
Danaparoid (Orgaran®)
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Formulary Injection

Restricted Item For prevention and treatment of thromboembolic disease in patients with a history of heparin-induced thrombocytopenia.
 
   
02.08.01  Expand sub section  Hirudins to top
02.08.01  Expand sub section  Heparin flushes
Heparin
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Formulary Flush solution

note For maintaining patency of peripheral venous catheters, sodium chloride injection 0.9% is as effective as heparin flushes. The role of heparin flushes in maintaining patency of arterial and central venous catheters is unclear (BNF).

All flush solutions must be prescribed. See NPSA Rapid Response Alert.  
Link  NPSA Rapid Response Report: Risks with Intravenous Heparin Flush Solutions
   
02.08.01  Expand sub section  Epoprostenol
Epoprostenol (Flolan®)
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Formulary Infusion 
   
02.08.01  Expand sub section  Fondaparinux
Fondaparinux (Arixtra®)
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Formulary
Green

Subcutaneous injection
Green Traffic Light Depends on indication - see GMMMG website for further details
Restricted Item Approved for:

  • Prevention of venous thromboembolic events in orthopaedic surgery
  • Treatment of acute coronary syndromes (from 4th Feb 2019)

Awaiting Trust-approved protocols for other indications.

 
Link  NCA: Guidelines for the Management of Patients with Suspected Acute Coronary Syndromes
   
 ....
 Non Formulary Items
Argatroban  (Exembol®)

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Non Formulary
 
Bemiparin

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Non Formulary
 
Bivalirudin  (Angiox®)

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Non Formulary
Link  NICE CG94: Unstable angina and NSTEMI
Link  NICE TA230: Bivalirudin for the treatment of STEMI, 2011
 
Dalteparin

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Non Formulary Subcutaneous injection
 
Lepirudin  (Refludan®)

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Non Formulary
 
Tinzaparin

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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
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
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

Amber

Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

Black

These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

Green

Not used   

Green 1

Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

Green 2

Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

Green 3

Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

Grey

Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

Red

Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

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