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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.03.02  Expand sub section  Drugs for arrhythmias
Ajmaline
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Unlicensed Drug Unlicensed
Red

injection 

Ventricular arrythmias where other options have failed.
Cardiology/ICU use only.

 
 
02.03.02  Expand sub section  Supraventricular arrhythmias
Dronedarone
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Formulary
Amber 1

Tablets 400mg

On advice of cardiology only

 
Link  MHRA Oct 2011: Cardiovascular, hepatic and pulmonary adverse effects - restrictions and monitoring requirements
Link  NICE TA197: Dronedarone for the treatment of non-permanent atrial fibrillation Link Shared Care Guideline: Amiodarone and Dronedarone
Link  Shared Care Protocol: Dronedarone for patients within adult services
 
Adenosine
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Formulary
Red
Injection 6mg/2mL 
 
02.03.02  Expand sub section  Supraventricular and ventricular arrhythmias
Amiodarone
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Formulary
Amber 1

Tablets 100mg, 200mg

On advice of cardiology only

 
Link  MHRA Drug Safety Update March 2022: Amiodarone (Cordarone X): reminder of risks of treatment and need for patient monitoring and supervision
Link  Shared Care Protocol: Amiodarone for patients within adult services
 
Disopyramide
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Formulary
Amber 0

Capsules 100mg, Tablets 250mg prolonged-release

On advice of cardiology only

 
 
Flecainide
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Formulary
Amber 0

Tablets 50mg, 100mg

On advice of cardiology only

 
 
Propafenone
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Formulary
Amber 0

Tablets 150mg, 300mg

Requires specialist supervision

 
 
Amiodarone
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Formulary
Red

Injection 150mg/3mL
Injection 300mg/10mL pre-filled syringe

 

 
Link  MHRA Drug Safety Update March 2022: Amiodarone (Cordarone X): reminder of risks of treatment and need for patient monitoring and supervision
 
Flecainide
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Formulary
Red
Injection 150mg/15mL 
 
02.03.02  Expand sub section  Ventricular arrhythmias
Mexiletine
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Formulary
Red

50mg, 100mg, 200mg (as hydrochloride)

Treatment of documented ventricular arrhythmias which, in the judgement of the physician, are considered as life-threatening.
For use by specialists in treating arrhythmias only.

 
Link  LSCMMG: Mexiletine
 
Lidocaine
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Formulary
Red

Ventricular arrhythmias

For cardiology/ICU use only

 
 
 ....
Key
Restricted Drug Restricted Drug
Unlicensed Drug Unlicensed
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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
ICB
ICB
Green Low Carbon

Low carbon footprint

Amber Medium Carbon

Medium carbon footprint

Red High carbon footprint

High carbon footprint

Status Description

Green

Green: Appropriate for initiation and ongoing prescribing in both primary and secondary care. Generally, little or no routine drug monitoring is required.  

Green Restricted

Green (Restricted): Appropriate for initiation and ongoing prescribing in both primary and secondary care provided: Additional criteria specific to the medicine or device are met, or The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway. Generally, little or no routine drug monitoring is required.   

Red

Red medicines: Medicine is supplied by the hospital for the duration of the treatment course. Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP. Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this. Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care.  

Amber 0

Amber level 0: Suitable for prescribing in primary care following recommendation or initiation by a specialist. Little or no specific monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Brief prescribing document or information sheet may be required. Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information. When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe.  

Amber 1

Amber level 1 (with shared care): Suitable for prescribing in primary care following recommendation or initiation by a specialist. Minimal monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care.  

Amber 2

Amber level 2 (with shared care and enhanced service): Initiated by specialist and transferred to primary care following a successful initiation period. Significant monitoring required on an on-going basis. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Suitable for enhanced service. These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements).  

Do Not Prescribe

Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria. Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need.  

Grey

Grey medicines: Medicines which have not yet been reviewed or are under the review process. GPs and specialists are recommended not to prescribe these drugs. This category includes drugs where funding has not yet been agreed.   

Multiple

Refer to local guidance and local commissioning arrangements  

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