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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.04  Expand sub section  Beta-adrenoceptor blocking drugs
 note 

Beta-blockers, especially when combined with a thiazide diuretic, should be avoided for the routine treatment of uncomplicated hypertension in patients with diabetes or in those at high risk of developing diabetes.

Elderly patients are particularly susceptible to the side effects of beta-blockers which include cold extremities, bradycardia, conduction disorders, heart failure, and fatigue. Reduced doses may be required in the elderly.

Bisoprolol
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First Choice
Green
Tablets
  • First choice beta-blocker in heart failure
  •  
    Atenolol
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    Second Choice
    Green
    Tablets, Oral Solution sugar free
  • Less suitable for prescribing in new patients
  •  
       
    Carvedilol
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    Second Choice
    Green
    Tablets
  • Heart failure only +/- alternative to bisoprolol
  •  
    Link  NICE CG108 - Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care
       
    Metoprolol
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    Second Choice
    Green
    Tablets
  • If short acting beta-blocker required
  •  
       
    Propranolol
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    Second Choice
    Green
    Tablets, Capsules MR, Oral Solution sugar free
  • Thyrotoxicosis, migraine and anxiety only
  •  
       
    Labetalol (Trandate)
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    Formulary
    Blue
    Tablets
  • Oral - Hypertension in pregnancy only, IV for hypertensive emergencies
  •  
    Link  NICE CG107 - Hypertension in pregnancy: The management of hypertensive disorders during pregnancy
       
    Nebivolol
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    Formulary
    Blue
    Tablets 5mg
  • Heart Failure only for patients aged over 70 years. Use 5mg tablets and halve if lower doses required
  • If 2.5mg has been prescribed, please change to 5mg as more cost-effective.(Nebivolol 2.5mg tablets cost 47.34 for 28, Nebivolol 5mg tablets cost 1.55 for 28, Drug Tariff Jan 2016)
  • Nebivolol 5mg Tablets can be divided into equal quarters.

     
  •    
    Sotalol
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    Formulary
    Blue
    Tablets
  • Restrict to the management of arrhythmias
  •  
    Link  NICE CG180 - Atrial fibrillation: the management of atrial fibrillation
       
     ....
     Non Formulary Items
    Acebutolol  (Sectral)

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    Non Formulary

    Capsules, tablets

     
    Celiprolol Hydrochloride

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    Non Formulary
     
    Co-Flumactone

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    Non Formulary
     
    Co-triamterzide

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    Non Formulary
     
    Dyazide

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    Non Formulary
     
    Frusene

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    Non Formulary
     
    Kalspare

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    Non Formulary
     
    Lasilactone

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    Non Formulary
     
    Nadolol

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    Non Formulary
     
    Oxprenolol

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    Non Formulary
     
    Pindolol

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    Non Formulary
     
    Timolol

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    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
    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

    Comment : Not to be routinely commissioned (prescribed) in any care setting (primary or secondary care). This may be due to a lack of good clinical evidence, cost effectiveness, concerns over safety or due to the availability of more suitable alternatives. As such, drugs classified as Black should be considered as non-formulary.   

    Red

    Initiation : Specialist only
    Repeat Prescribing : Specialist
    Monitoring : Specialist
    Comment : Prescribing must be in line with any specific treatment criteria outlined. In exceptional circumstances a GP may be asked to prescribe the specialist must provide adequate information and support.   

    Amber

    Initiation : Specialist only
    Repeat Prescribing : Primary care OR specialist
    Monitoring : Primary care OR specialist
    Comment : Monitoring according to Effective Shared Care Agreement (ESCA) for stabilised patients only. GP agreement should be requested by specialist and confirmed/declined by GP on a patient-by-patient basis.   

    Blue

    Initiation/Recommendation : Specialist only
    Repeat Prescribing : Primary care
    Monitoring : Primary care
    Comment : Should be initiated or recommended by a specialist. Monitoring of either medicine or disease does not require specialist skills or equipment   

    Green

    Initiation : Primary care or specialist
    Repeat Prescribing : Primary care
    Monitoring : Primary care
    Comment : Suitable for non specialist initiation   

    OTC

    Patients should be advised to purchase if approriate.  

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