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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.08.02  Expand sub section  Oral anticoagulants
Rivaroxaban
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Formulary
Green
Treatment of DVT or PE:
  • GPs may initiate in line with local guidance.
  • Treatment of ACS:
    - Specialist initiation only, awaiting local guidance

    GPs may continue after specialist initiation. See Primary care guideline and prescribing information sheet

    Prophylaxis of VTE post hip and knee replacement surgery:
    Complete course will be supplied by hospital, to start upon discharge. Post-op whilst in-patient to be treated with parenteral anticoagulants

  • If needed tablets can be crushed and dispersed in water. 
  • Link  NICE TA256: Rivaroxaban for AF
    Link  NICE TA261: Rivaroxaban for treatment of DVT
    Link  NICE TA287: Rivaroxaban for treating PE and preventing recurrent venous thromboembolism
    Link  Rivaroxaban reversal guideline (BTHFT)
       
    Acenocoumarol
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    Restricted Drug Restricted
    Green Specialist Initiation
    Tablet
  • Only used for those patients intolerant of warfarin and phenindione, or existing patients 
  •    
    Apixaban
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    Formulary
    Green
    Tablets 2.5mg amd 5mg

    POSITION STATEMENT TO ADD 
    Link  NICE TA275: Stroke and systemic embolism (prevention, non-valvular atrial fibrillation) - apixaban (TA275)
       
    Dabigatran
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    Formulary
    Green
    Capsules 75mg, 110mg and 150mg

    Rivaroxaban is the oral anticoagulant of choice for prophylaxis of VTE following total knee and hip replacement

    POSITION STATEMENT TO ADD IN REGARDS TO ROLE IN STROKE AND AF 
    Link  NICE TA249: Dabigatran for Stroke prevention in AF
       
    Warfarin
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    Formulary
    Green
    Tablets 0.5mg (white) 1mg (brown), 3mg (blue,) 5mg (pink),
    Suspension 1mg/ml (licensed) - 99 per 150ml
  • If needed tablets can be crushed and dispersed in water.

     
  • Link  UKMI Q&A: IM injections in warfarin patients
    Link  UKMI Q&A: Warfarin and PPI interaction
       
    Phenindione
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    Restricted Drug Restricted
    Green
    Tablet
  • For patients intolerant of warfarin
     
  •    
    02.08.02  Expand sub section  Stroke prevention in AF
     note  At present, warfarin remains our first line agent for stroke prevention in AF, however Rivaroxaban is an option for some patients as per NICE guidance. In particular, it should be considered in those patients intolerant of warfarin, those with a poorly controlled INR or those who chose a NOAC over warfarin after a discussion regarding the risks and benefits has taken place
    02.08.02  Expand sub section  Atrial Fibrillation
    02.08.02  Expand sub section  VTE treatment
    02.08.02  Expand sub section  VTE prophylaxis in hip/knee surgery to top
     ....
    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

    Medicines suitable to be prescribed in primary care after Specialist* recommendation or initiation. A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust D&TC(s). *Specialist is defined as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice.   

    Amber 1

    Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (D&TC) * All drugs awaiting the production or approval of a shared care guideline default to RED   

    Cancer Drug Fund

    Cancer Drug Fund   

    Green

    Medicines suitable for routine use and can be prescribed within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.  

    Green Specialist Initiation

    These drugs should be initiated only by a hospital or specialist clinician (GPSi) but there is no requirement for additional monitoring over the general requirements for all medicines. Some may require short or medium specialist monitoring of efficacy or dose titration before transferring in Primary care. The GP should have all the information they require to support continued prescribing.   

    Green Specialist Recomendation

      

    Grey

    Grey - Medicines, which the Drug & therapeutics Committee has actively reviewed and does not recommend for use at present following a review of clinical and/or cost effective data. Grey (assessment in progress) - will be reviewed at a future D&T meeting. Grey (awaiting submission) - The D&T are awaiting a submission from an appropriate practitioner. If you wish to make a submission for this medicine to be added to the formulary please email drug.information@bthft.nhs.uk .   

    Non Formulary

    Not recommended for prescribing as initial therapy, but can be continued if patient already stable on treatment   

    Red

    Medicines which should normally be prescribed by specialists only. ** For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care   

    RED ULM

    Unlicensed Medication  

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