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Nottinghamshire Area Prescribing Committee
Joint Formulary
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.06.01  Expand sub section  Nitrates
Glyceryl Trinitrate
View adult BNF View SPC online View childrens BNF
Formulary
Green
Available as S/L Tablet, Spray, Patches, Injection.
  • Injection (secondary care only)- Use Polyethylene (PE), giving set for infusion (NOT PVC!).
  • Buccal tablets (Suscard) discontinued 2008 - Alternatives include IV/sublingual GTN or oral Isosorbide Mononitrate depending on the indication. 
  • Link  SFH guide for use in ICCU
    Link  SFH IV GTN guidelines
    Link  SFH: IV drugs which need special giving sets
    Link  SFH: IV GTN monitoring sheet for hypertension in Acute Stroke
       
    Glyceryl Trinitrate 2% Ointment
    Formulary
    Red

    Ointment

    Available at NUH only for:

    • Treatment and prevention of digital gangrene in children and young people with severe septic shock (unlicensed indication).
     
       
    Isosorbide Mononitrate
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablet
  • Short acting preparations should be prescribed asymmetrically to reduce the risk of nitrate tolerance
  • Tablets disperse in water if needed. Do not crush MR preperations. See here for general advice on dispersing tablets. 
  • Link  PrescQIPP: ISMN review
       
    Isosorbide Mononitrate MR
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Tablet

    • Long acting, once daily preparation
    • Preferred brands in primary care are Tardisc or Monomil
     
       
    Isosorbide Dinitrate
    (Injection)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Injection- Isoket (secondary care only)
  • At SFH injection is restricted for intracoronary use on Cardiac Catheter Suite. (For IV use GTN)
     
  •    
     ....
     Non Formulary Items
    Glyceryl Trinitrate
    (AEROSOL spray)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Use the PUMP spray as this is much less expensive than the aerosol spray.
  •  
    Isosorbide Dinitrate
    (Oral)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Prodrug of isosorbide mononitrate - use that instead.
     
      
    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

    Grey

    Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.
    Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting.
    Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
      

    Red

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

    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) (DTC) and approved by the Nottinghamshire APC.
      

    Amber 2

    Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
    A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
    *Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
      

    Amber 3

    Primary care/ non specialist may initiate as per APC guideline.
    The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
      

    Green

    Medicines suitable for routine use within primary care.
    Can be initiated 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.   

    OTC

      

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