| GREEN Glyceryl trinitrate |
| tablets sublingual 500 microgram |
| buccal tablets 2mg, 5mg |
aerosol spray 400micrograms/dose
|
patches 5mg/24hr, 10mg/24hr
|
RED Glyceryl trinitrate injection 25mg/5ml, 50mg/50mL
|
| |
| Isosorbide mononitrate M/R |
| Standard release preparations have been replaced with the following modified release (M/R) products. These should be |
| prescribed generically. A guide detailing how to switch from standard formulation to modified release preparations can |
| be found here |
| GREEN Isosorbide mononitrate XL 60mg tablets, |
Isosorbide mononitrate LA 25mg, 50mg capsules
|
| |
| 2.6.2 Calcium Channel Blockers |
| Amlodipine is for angina and hypertension, has a longer duration of action and can be given once a day. |
| It should be prescribed generically as amlodipine. The besilate salt should not be prescribed as this is more expensive. |
| GREEN Amlodipine (as maleate/mesilate salt only) tablets 5mg, 10mg |
| |
| Lercanidipine or Lacidipine can be used as a second line calcium channel blocker when amlodipine is not tolerated |
| (e.g. where patients develop significant ankle oedema). |
| GREEN Lercanidipine tablets 10mg, 20mg |
| GREEN Lacidipine tablets 2mg, 4mg |
| |
| Diltiazem is indicated for angina and hypertension. Prescribe modified-release diltiazem by brand name to avoid |
| confusion between different formulations. |
| |
| Diltiazem (once daily preparations) |
GREEN Zemtard XL (Prescribe by brand name) capsules 120mg, 180mg, 240mg, 300mg
Slozem capsules 120mg, 180mg, 240mg, 300mg (1st line in hospital) |
| Viazem® XL (prescribe by brand name) 120mg, 180mg, 240mg, 300mg, 360mg (3rd line and in-case of |
| supply disruption) |
| GREEN Diltiazem MR 60mg tablets [to support dose titration options in CCU] |
| |
| Nimodipine is licensed only for subarachnoid haemorrhage. |
| RED Nimodipine tablets 30mg |
| RED Nimodipine intravenous infusion 10mg/50mL |
| |
| Verapamil is for angina, hypertension and arrhythmias, it reduces cardiac output, slows the heart rate and may |
| precipitate heart failure. |
| GREEN Verapamil |
| tablets 40mg, 80mg, 120mg |
| tablets m/r 120mg, 240mg |
| RED Verapamil injection 5mg/2mL |
| |
| Nicardipine IV for use on Critical Care Unit ELHT only, where beta-blockers not tolerated |
| RED Nicardipine IV |
| |
| Nifedipine MR - Hypertension during pregnancy and post-natal only |
| AMBER Nifedipine MR tablets 10mg, 20mg |
| |
| 2.6.3 Other antianginal drugs |
| Nicorandil |
| Nicorandil, a potassium channel activator with a nitrate component, has both arterial and venous dilating properties |
| and is licensed for the prevention and long-term treatment of chronic stable angina pectoris. It is usually prescribed in |
| addition to isosorbide mononitrate if symptoms remain uncontrolled. Patients already receiving MAXIMAL therapy |
| with two antianginal medications (e.g. calcium channel blocker and nitrates) should be referred to a specialist for |
| further assessment. |
| GREEN Nicorandil tablets 10mg, 20mg |
| |
| Ivabradine [See Prescribing Guidance for GP's] |
| Chronic Stable Angina |
| ° Ivabradine should only be initiated by specialists in the treatment of chronic stable angina. |
| ° Ivabradine has not demonstrated any increased benefits in terms of efficacy and safety over other available |
| treatments for angina, and is considerably more expensive. |
| ° It is recommended for symptomatic treatment of chronic stable angina pectoris in patients with normal sinus |
| rhythm for whom heart rate control is desirable and for whom beta-blockers and calcium-channel blockers are |
| inappropriate or not tolerated. Long-term protection against cardiovascular events, however, has not been |
| demonstrated. |
| ° Therefore patients already receiving MAXIMAL therapy with two antianginal medications (e.g. calcium channel |
| blocker and nitrates) should be referred to a specialist for further assessment. |
| ° There is no evidence that addition of a third drug improves symptom control. If a third drug (e.g. nicorandil) is |
| introduced while awaiting an outpatient appointment, its effects should be monitored and if it has no effect it should |
| be stopped. |
| GREEN Ivabradine tablets 5mg, 7.5mg [See Prescribing Guidance for GP's] |
| |
| Chronic Heart Failure |
| Ivabradine should only be initiated by specialists in the treatment of chronic heart failure |
| AMBER Ivabradine tablets 5mg, 7.5mg see prescribing information sheet |
| |
| Ivabradine prior to Cardiac CT if required to lower the heart rate |
| RED Ivabradine for use prior to cardiac CT when the heart rate is raised |
| |
| Ranolazine |
| Ranolazine is recommended as add on therapy for symptomatic treatment of patients with stable angina |
whose symptoms are inadequately controlled or intolerant of first-line anti-anginal therapies, nitrates and/or ,
|
nicorandil and third line ivabradine.
|
| > Ranolazine is recommended as add on therapy for symptomatic treatment of patients with stable angina whose |
| symptoms are inadequately controlled or intolerant of first-line antianginal therapies, nitrates and/or Nicorandil, |
| and third line |
| > Ivabradine and when there are no re-vascularisation options available to the patient |
| > Patients who experience a satisfactory response (reviewed by cardiologist after 3 months) may have their care |
| transferred to primary care |
| See Guidance for Prescribers/ quick reference guide for ranolazine |
| GREEN Ranolazine m/r tablets 375mg, 500mg, 750mg |
| |
2.6.4 Peripheral vasodilators and related drugs
|
| Nifedipine may be useful for reducing the frequency and severity of vasospastic attacks in Raynaud’s syndrome. |
| [Nifedipine immediate release capsules have been discontinued and the use of MR 10mg, 20mg BD has been approved for use] |
| Nifedipine is no longer recommended for the treatment of hypertension and angina. |
| GREEN Nifedipine MR 10mg, 20mg |
| |
| Post-natal hypertenion only |
| AMBER Nifedipine MR 10mg, 20mg |
| |
| Sildenafil, as an option in severe primary or secondary Raynaud’s resistant to initial therapies (calcium channel blockers). |
| Unlicensed Use |
| RED Sildenafil tablets 25mg |
| |
| NICE guidance for peripheral arterial disease (TAG 223) |
| Naftidrofuryl oxalate is recommended as an option for the treatment of intermittent claudication in people with |
| peripheral arterial disease for whom vasodilator therapy is considered appropriate after taking into account |
| other treatment. Treatment with naftidrofuryl oxalate should be started with the least costly licensed preparation i.e. |
| generic prescribing only. |
| GREEN Naftidrofuryl oxalate capsules 100mg |
| |
| BACK to main chapter |
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