netFormulary NHS
Buckinghamshire Formulary
Buckinghamshire Healthcare NHS Trust
Buckinghamshire CCG
 Search
 Formulary Chapter 2: Cardiovascular system - Full Chapter
Chapter Links...
 Details...
02.08.01  Expand sub section  Parenteral anticoagulants
ACD-A Anticoagulant Citrate Dextrose
(solution)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red

 Restricted - for use in theatres for cell salvage.


 
   
Argatroban 250mg in 2.5mL
(concentrate for solution for infusion - vial)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red

Prescribing on the advice of a consultant Haematologist for HIT in accordance with interim guidance on diagnosis and management of thrombosis and thrombocytopenia occurring after COVID-19 vaccination : guidance-version-07-on-mngmt-of-thrombosis-with-thrombocytopenia-occurring-after-c-19-vaccine_20210330_.pdf (b-s-h.org.uk)

 
   
02.08.01  Expand sub section  Heparin
Heparin Calcium 5000units/0.2mL
(injection)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Heparin Sodium 10,000units/10mL, 20,000units/20mL
(for infusion)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Heparin Sodium 1000units/1mL
(injection)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Heparin Sodium 25,000units/5mL
(injection)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Restricted - For use in Renal Unit Only as detailed in the Renal Unit Policy for managing Dialysis Catheters. 
   
Heparin Sodium 5000units/0.2mL
(injection)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Heparin Sodium 5000units/5mL
(injection)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Heparin Sodium/Sodium Chloride 1000units/0.9%
(infusion)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
02.08.01  Expand sub section  Low molecular weight heparins
Dalteparin Sodium 10,000units/1mL (Fragmin®)
(graduated syringe)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
To be used for treatment and prevention of DVT and PE.
1. Restricted - for hospital only use when prescribed for treatment doses (exceeding 5000units daily) and for all indications for use within obstetrics and gynaecology.  
   
Dalteparin Sodium 2500units/0.2mL, 5000units/0.2mL, 10,000units/0.4mL, 12,500units/0.5mL, 15,000units/0.6mL, 18,000units/0.72mL (Fragmin®)
(injection, single-dose syringe)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
To be used for treatment and prevention of DVT and PE.
1. Restricted - for hospital only use when prescribed for treatment doses (exceeding 5000units daily) and for all indications for use within obstetrics and gynaecology.  
   
Dalteparin Sodium 2500units/0.2mL, 5000units/0.2mL (Fragmin®)
(injection, single-dose syringe)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber Initiation
To be used for treatment and prevention of DVT and PE.
2. Restricted - to prescribing in accordance with, Dalteparin for prophylactic use in Surgery, Oncology, Haematology and Medicine amber initiation guideline (BHTCG 116FM)
NOTE: for amber initiation the first 6 weeks supply to be provided by hospital. 
Link  Dalteparin for Prophylactic use in Surgery, Oncology, Haematology & Medicine Amber Initiation guideline (BHTCG 116)
   
02.08.01  Expand sub section  Heparinoids
Danaparoid Sodium 750mg/0.6mL
(injection)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Restricted - prescribing only on the advice of a Consultant Haematologist, for heparin induced thrombocytopenia (HIT) 
   
02.08.01  Expand sub section  Hirudins to top
Bivalirudin 250mg
(injection)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Restricted - prescribing by Cardiologists only for patients intolerant to first line treatment options for ACS STEMI and in accordance with NICE TA 230 Bivalirudin for the treatment of ST-segment-elevation myocardial infarction.  
Link  MHRA Drug Safety Update: Risks associated with non approved bivalirudin regimes
Link  NICE TA230: Bivalirudin for the treatment of STEMI, 2011
   
02.08.01  Expand sub section  Heparin flushes
Heparin Sodium 200units/2mL
(sterile solution)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber Initiation
Restricted - to initiation in secondary care with continuation by GPs 
   
Heparin Sodium 50units/5mL
(sterile solution)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber Initiation
Restricted - to initiation in secondary care with continuation by GPs 
   
02.08.01  Expand sub section  Epoprostenol
Epoprostenol 500micrograms
(infusion)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Red Traffic Light 1. Restricted - for use on NICU, ITU and SCBU only

Red Specialist Centre 2. Restricted - prescribing by Respiratory consultants only after initiation in a Specialist Centre. May be continued in BHT via shared care between Specialist centre and BHT via a network model. For pulmonary arterial hypertension in accordance with NHSE Specialised Commissioning Policy A11/P/b, June 2014: National policy for targeted therapies for the treatment of pulmonary hypertension in adults. The name of the Specialist centre and consultant initiating drug to be communicated to Pharmacy Formulary Team prior to prescribing. 
Link   NHSE Commissioning Policy A11/P/b: National Policy for targeted therapies for the treatment for the treatment of pulmonary hypertension in adults
   
02.08.01  Expand sub section  Fondaparinux
Fondaparinux Sodium 2.5mg/0.5mL, 5mg/0.4mL, 7.5mg/0.6mL
(prefilled syringe)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red

Restricted to:
1. Prescribing by acute medical team for suspected ACS. Refer to ICP for ACS.
2. Prescribing by Consultant Haematologists for patients intolerant of dalteparin (eg. due to heparin-induced thrombocytopenia (HITT), skin rash)

 
   
 ....
 Non Formulary Items
Enoxaparin  (Clexane®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary In primary care - see dalteparin - our usual LMW heparin choice. If Clexane is recommended by a hospital other than BHT we expect the supply to remain within that hospital
 
Lepirudin  (Refludan®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tinzaparin  (Innohep®)

View adult BNF View SPC online View childrens BNF Track Changes
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

Black

Not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.
Drugs which have been evaluated and rejected by the Medicines Value Group (MVG)
Drugs defined as ‘Low Priority’ by the South Central Priorities Committee
New drugs which have not as yet been evaluated by the MVG
Any drug not listed in the Buckinghamshire Formulary  

Red

Drugs which should only be prescribed in secondary care by a specialist.
Require specialist knowledge and/or equipment for patient selection and initiation
Require long term on-going monitoring and dose adjustment to ensure efficacy and minimise toxicity by a specialist
Designated as “hospital only“ by product licence, NICE, DoH or BNF
May need further evaluation by a specialist
Are hospital initiated clinical trial materials  

Red Specialist Centre

As for ‘red’ (above) with the addition of the following:
Designated by NHS England to require initiation by or in prior agreement with a Specialist Centre. Continuation where appropriate by BHT (or other secondary care provider)
Detailed requirements for Specialist Centre initiation to be described in the wording of the formulary restriction  

Amber Protocol

Drugs which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a drug specific Shared Care Protocol(SCP). Prescribing may be continued in primary care following the SCP
Require specialist knowledge and/or equipment for patient selection and initiation
Require short or medium term (eg. 3 to 6 months) specialist monitoring of efficacy or toxicity. The need for stabilisation will vary with different drugs and patients, but is usually a minimum of 2 months (see principles for shared care)
Require significant long term monitoring
Require ongoing communication between the GP and the specialist
Have clearly defined consultant, GP and patient responsibilities documented in a shared care protocol (see responsibilities for amber protocol drugs)  

Amber Initiation

Drugs suitable for primary care prescribing following specialist initiation
Require specialist knowledge and/or equipment for patient selection
Monitoring does not require specialist knowledge or equipment
If the drug is one with which the primary care prescriber is unfamiliar the specialist is expected to provide sufficient information on the drug indication, dose, duration , monitoring and any further necessary dose adjustments
Require the first prescription to be written by the specialist  

Amber Recommended

Drugs suitable for primary care prescribing following specialist recommendation
As for amber initiation except that:- The first prescription may be written by the GP after specialist recommendation.  

Green

Drugs for which primary care prescribers would normally take full responsibility for prescribing and monitoring
Drugs not included in the Traffic Light list but included on joint formulary.
New drugs classified as red or amber but as greater experience regarding their safety and efficacy is established may move to Green after re-consideration by the MVG and APC.  

netFormulary