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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.02.03  Expand sub section  Potassium-sparing diuretics and aldosterone antagonists
 note 

Monitor serum potassium levels regulary

Amiloride Hydrochloride
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First Choice
Green
 
02.02.03  Expand sub section  Aldosterone antagonists
 note 

Potassium supplements should not be prescribed with aldosterone antagonists and serum potassium should be monitored

Spironolactone potentiates thiazide or loop diuretics.

Eplerenone is licensed as an adjunct in left ventricular dysfunction with evidence of heart failure after myocardial infarction and as an adjunct in chronic mild heart failure with left ventricular systolic dysfunction.

 

Spironolactone
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First Choice
Green
 
Eplerenone
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Second Choice
Green plus

Licensed as:

An adjunct in stable patients with left ventricular ejection fraction<40% with evidence of heart failure, following a myocardial infarction (start treatment within 3-14 days)

An adjunct in chronic mild heart failure with left ventricular ejection fraction<30%

 
Link  NICE CG108: Chronic heart failure
   
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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
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Link to adult BNF
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Link to children's BNF
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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

Green

Drugs that may be initiated, stabilised and maintained by primary, secondary or tertiary care Secondary and tertiary care prescribing may be continued by primary care. [this does not indicate first/second line choice]  

Green Hospital

Items used by the Hospital but would not normally be continued into primary care. Primary care prescribers can change to GREEN first or second.   

Green plus

Initiation of drugs by primary care following written advice from secondary/ tertiary care advice. These can then be continued by primary care with little or no monitoring requirements.  

Yellow

Drugs that may be continued in primary care following initiation and stabilisation in secondary/tertiary care  

Advice

Drugs which require initiation by secondary or tertiary care. These should be continued until patient stabilised. Once stable an agreement with the GP should be met to take over prescribing and any monitoring between specialist reviews. The specialist will provide prescribing guidelines for the management of these patients.  

Amber

Items requiring a shared care agreement. These items should be initiated and stabilised by secondary or tertiary care. The GP should only be asked to take over prescribing through a formal shared care agreement. Secondary care will be expected to continue prescribing until the agreement is made.  

Red

Hospital/ Trust ONLY. These are items the secondary and tertiary care are responsible for prescribing and will need to continue to prescribe for long term maintenance. These items will NOT be prescribed in primary care. But primary care should be informed the patient is receiving these items. This will include NHSE funded items requiring repatriation.  

GP - Black

Items covered by NHSE ‘Should not prescribe in primary care list’ – See CCG policy on Drugs of limited clinical value  

GP - Grey

Grey List: Items covered by NHSE ‘Should not prescribe in primary care list’ that are not to be routinely prescribed but may be suitable in a defined population – See CCG policy on Drugs of limited clinical value  

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