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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.12  Expand sub section  Lipid-regulating drugs
02.12  Expand sub section  Statins
 note 

If intolerance to statins is a problem, this should be managed by dose reduction or the use of an alternative statin in preference to commencing alternative lipid lowering agents such as ezetimibe.

Atorvastatin
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First Choice

Tablets

note 30mg and 60mg tablets are not to be prescribed

 
Simvastatin
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First Choice Tablets
 
Pravastatin
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Formulary Tablets 
   
Rosuvastatin
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Formulary Tablets

Approved for use in PAHNT for patients who have not achieved target levels with other statins. 
   
02.12  Expand sub section  Bile acid sequestrants
Colestyramine
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Formulary Powder  
   
02.12  Expand sub section  Ezetimibe
Ezetimibe (Ezetrol®)
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Formulary Tablets

Not licensed for primary or secondary prevention of cardiovascular disease.  
Link  NICE TA132: Hypercholesterolaemia - ezetimibe
   
02.12  Expand sub section  Fibrates to top
Fenofibrate
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Formulary Capsules
Tablets

Fenofibrate has similar efficacy to bezafibrate in the reduction of triglycerides and is more potent in terms of LDL reduction and HDL elevation.

 
   
02.12  Expand sub section  Nicotinic acid group
02.12  Expand sub section  Omega-3 fatty acid compounds
Omega-3-Acid Ethyl Esters
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Formulary
Grey
Capsules

Restricted Item Should only be used for the treatment of hypertriglyceridaemia under the care of a lipid management specialist.

Omega-3-Acid Ethyl Esters are NOT recommended for the secondary prevention of Myocardial Infarction. See GMMMG IPNTS recommendation.  
Link  GMMMG IPNTS Recommendation: Omacor Capsules
Link  NICE CG181: Lipid Modification
Link  NICE Evidence Summary: schizophrenia - omega-3 fatty acid medicines
   
02.12  Expand sub section  Other lipid modifying agents
Evolocumab (Repatha®)
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First Choice
Red
High Cost Medicine
Pre-filled syringe
Pre-filled pen
Only as per NICE TA394.
Requires completion of Blueteq form prior to initiation.
Available via Homecare providers.

 
Alirocumab (Praluent®)
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Second Choice
Red
High Cost Medicine
Pre-filled syringe
Pre-filled pen
Restricted Item For patients with latex allergy or intolerance to evolocumab

Only as per NICE TA393.
Requires completion of Blueteq form prior to initiation.
Available via Homecare providers.

 
Link  NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
Link  GMMMG Pathway: PCSK9 inhibitors in the treatment of hypercholesterolaemia
   
 ....
 Non Formulary Items
Acipimox  (Olbetam®)

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Non Formulary
 
Bezafibrate

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Non Formulary
 
Ciprofibrate  (Modalim®)

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Non Formulary
 
Colesevelam  (Cholestagel®)

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Non Formulary
 
Colestipol Hydrochoride  (Colestid®)

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Non Formulary
 
Fluvastatin  (Lescol® XL)

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Non Formulary
 
Fluvastatin  (Lescol®)

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Non Formulary
 
Gemifibrozil

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Non Formulary
 
Nicotinic Acid  (Niaspan®)

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Non Formulary
 
Omega-3-Marine Triglycerides  (Maxepa®)

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Non Formulary
Link  NICE: schizophrenia - omega-3 fatty acid medicines
 
Simvastatin and Ezetimibe  (Inegy®)

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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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