Tablets 62.5 micrograms, 125 micrograms, 250 micrograms
Liquid 50 micrograms/1mL

Injection 500 micrograms/2mL 

Oral digoxin is the preferred route. Intravenous digoxin should only be used when oral route is unavailable. Digoxin has a narrow therapeutic index and can cause toxicity.

Intravenous infusion 40mg

Critical care use only

Critical care use only

Tablets 2.5mg 

Modified release tablets 1.5mg

First line diuretic for hypertension

Tablets 2.5mg, 5mg

Tablets 2.5mg, 5mg

Treatment of patients with chronic heart failure with resistant volume overload

Must be prescribed by brand

Use the licensed preparation for new patients.

Before requesting primary care prescribing, patients must be established on a stable dose of metolazone for at least 2 weeks, with stable urea and electrolytes (including creatinine) and a stable body weight before discharge.

Ongoing monitoring of urea and electrolytes (including creatinine) should be carried out on a monthly basis and the patients’ weight and blood pressure should be monitored at each clinic visit.

Metolazone has an established role in the treatment of resistant oedema in heart failure where it is combined with a loop diuretic. The combination of metolazone and a loop diuretic is much more potent and needs to be initiated by someone experienced in its use and needs careful monitoring of renal function and electrolytes. It is routinely used in patients with renal impairment who do not respond to a loop diuretic.

Tablets 1mg, 5mg

Injection 

Tablets 25mg, 50mg, 100mg

Heart failure

Tablets 25mg, 50mg

Intravenous infusion 10%, 15%, 20%

Injection 

Ventricular arrythmias where other options have failed

Cardiology and Critical Care use only

Tablets 400mg

Tablets 100mg, 200mg

Capsules 100mg

Modified-release tablets 250mg

Tablets 50mg, 100mg

Tablets 150mg, 300mg

Requires specialist supervision

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

Capsules 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.

Injection

Ventricular arrhythmias.

Cardiology and Critical Care use only.

Tablets 3.125mg, 6.25mg, 12.5mg, 25mg

Second line (heart failure)

Tablets 25mg, 50mg, 100mg
Liquid 25mg/5mL

Second line

Tablets 100mg, 200mg

Hypertension in pregnancy

Tablets 50mg

Option when a beta blocker with a short half-life is required

Tablets 5mg
Tablets 2.5mg (for dose titration only)

Third line

Tablets 40mg, 80mg

Arrhythmias (on advice of cardiology only)

Injection 100mg/10mL
Infusion 2.5g in 250mL

Injection 100mg/20mL

Hypertension in pregnancy and hypertensive crisis

Tablets 25mg, 50mg

 Hypertension

 Heart failure (Initiated in hospital or under specialist supervision)

Tablets 20mg

Tertiary centre only

Sildenafil and bosentan are licensed for use in pulmonary arterial hypertension (PAH). Treatment of this condition is commissioned nationally through a small number of PAH centres based in hospitals across the UK.
All patients should be referred to one of these centres, who carry out all prescribing of these therapies.

Injection 50mg vials  

Specialist use only

Tablets 125mg, 250mg, 500mg

Tablets 200micrograms, 300micrograms, 400micrograms

 Restricted to use in resistant hypertension

Tablets 25 microgram 

 Vasomotor symptoms (VMS) associated with menopause

 Clonidine is considered less suitable for prescribing in hypertension

Tablets 1mg, 2mg, 4mg

 Doxazosin modified-release tablets 

Capsules 10mg

Injection

Critical care and theatre use only

Tablets 10mg, 25mg

Tablets 2mg, 4mg, 8mg

Perindopril ARGININE is considered ‘Not suitable for prescribing’.

Tablets 2.5mg, 5mg, 10mg, 20mg

 Restricted to use in post-natal women, in line with NG133.

Tablets 75mg, 150mg, 300mg

Film-coated tablets
24.3 mg sacubitril and 25.7 mg valsartan (as sacubitril valsartan sodium salt complex).
48.6 mg sacubitril and 51.4 mg valsartan (as sacubitril valsartan sodium salt complex).
97.2 mg sacubitril and 102.8 mg valsartan (as sacubitril valsartan sodium salt complex).

Entresto® tablets and granules contain sacubitril and valsartan in the form x/y where x and y are the strength in milligrams of sacubitril and valsartan respectively. Doses in BNF Publications are expressed as the total of both drug strengths.

tablets and capsules

Existing patients only

Tablets 10mg, 20mg
M/R tablets 60mg
LA capsules 25mg, 50mg

Aerosol spray 400micrograms/dose
Patches 5mg/24h, 10mg/24h

Patches should only be considered in patients unable to comply with or tolerate oral isosorbide mononitrate.

Infusion

Tablets 10mg, 20mg

Option when amlodipine is not tolerated (e.g. where patients develop significant ankle oedema)

M/R tablets 2.5mg, 5mg, 10mg 

A second line dihydropyridine calcium channel blocker when amlodipine is not tolerated (e.g. where patients develop significant ankle oedema).

For existing patients only

Tablets 30mg
Intravenous infusion 10mg/50mL

Prevention and treatment of ischaemia following subarachnoid haemorrhage

For use only within licensed indications following aneurysmal subarachnoid haemorrhage.

Tablets 40mg, 80mg, 120mg
M/R tablets 120mg, 240mg
Liquid 40mg/5mL

Prescribe diltiazem modified-release preperations by brand name.

There may be variation in brands between hospital Trusts. Follow local Trust policy regarding brand switches.

Injection 10mg/10mL

Specialist use only

Tablets 10mg, 20mg

M/R tablets 375mg, 500mg, 750mg

 Restricted to use in line with CG126.

Tablets 5mg, 7.5mg

Capsules 100mg

Severe Raynaud's phenomena

Specialist use only

Pulmonary hypertension

For use by specialist centres only.

Tablets 25mg

Digital ulceration 

Specialist initiation only

Injection 500micrograms

Specialist initiation only

Digital ulcers  
Pulmonary arterial hypertension 

Infusion

Injection

 Unlicensed

Tablets 2.5mg, 5mg

Postural hypotension

Intravenous infusion

Critical care and theatre use only

Healthcare professionals should be aware of the differences in strength and presentation between noradrenaline products.

Injection

Injection 1mg/10mL amp, 1mg/10mL pre-filled syringe

Solution for infusion 50mg/50ml 

Concentrate for solution for infusion 250mg/2.5ml

Infusion 250mg

Injection 1000units/1mL, 10 000units/10mL, 20 000units/20mL

Refer to local Trust guidance for advice on the prescribing and monitoring of low molecular weight heparins.

Care when prescribing/selecting strength of syringes - Different strengths available. 

Refer to local Trust guidance for advice on the prescribing and monitoring of low molecular weight heparins.

Refer to local Trust guidance for advice on the prescribing and monitoring of low molecular weight heparins.

Care when prescribing/selecting strength of syringes - Different strengths available

Anticoagulation where standard options are contra-indicated.
Use only following haematologist advice.

Flush 50units/5mL

Arterial line patency

Critical care use only

Injection 500micrograms

Specialist initiation only

Renal dialysis when heparins are unsuitable or contra-indicated

Injection 1.5mg in 0.3mL, 2.5mg in 0.5mL, 5mg in 0.4mL, 7.5mg in 0.6mL, 10mg in 0.8mL

Tablets 2.5mg, 5mg

  Apixaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation (NICE TA275)

Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults (NICE TA245)

Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism (NICE TA341)

  Use in patients with limb casts. Use according to Trust protocols.

Tablets 2.5mg, 10mg, 15mg, 20mg

  Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation (NICE TA256)
 
Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults (NICE TA 170)

Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome (NICE TA335) 

Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism (NICE TA261) 

Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism (NICE TA287) 

 *10mg tablets* Treatment of DVT and PE, and extended prevention of recurrent DVT and PE in adults

  Use in patients with limb casts. Use according to Trust protocols.

tablets 15mg, 30mg, 60mg
 
Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation (NICE TA355)

Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism (NICE TA354)

  Use in patients with limb casts. Use according to Trust protocols.

Capsules 110mg, 150mg

Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation (NICE TA249)

Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults (NICE TA157)

  Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism (NICE TA327) 

  Use in patients with limb casts. Use according to Trust protocols.

Tablets 2.5mg

Prevention of cardiac events in patients with coronary (CAD) or peripheral artery Disease (PAD)

  East Lancashire only

Tablets 1mg, 3mg, 5mg

Treatment of venous thromboembolism

Prevention of stroke and systemic embolism in non-valvular atrial fibrillation

Tablets 1mg

Second line vitamin K antagonist

Powder for solution for infusion 200mg

Solution for injection/infusion 2.5 g/50 mL

Rapid reversal of anticoagulant effects of dabigatran  

Injection 50mg/5mL

Dispersible tablets 75mg, 300mg

The use of enteric coated aspirin 75mg is not recommended

Tablets 25mg, 100mg
Modified-release capsules 200mg

Tablets 5mg, 10mg

Tablets 60mg, 90mg

Follow local policy

Follow local policy

Follow local policy

Follow local policy

Specialist use only

Tablets 10mg, 20mg, 40mg

Tablets 5mg, 10mg, 20mg

Tablets 10mg, 20mg, 40mg

Restricted to use in patients who cannot tolerate other statins.

Powder 4g/sachet

Tablets 625 mg

Cardiovascular Disease prevention in hyperlipidaemia when the patient is intolerant of all other options.

Tablets 10mg

Tablets 200mg
Modified-release tablets 400mg

Capsules (micronised) 200mg, 267mg
Tablets (micronised) 160mg

 To reduce the progression of diabetic retinopathy for people with non-proliferative retinopathy and type 2 diabetes (unlicensed indication). Ophthalmologist recommendation or initiation only. The GP should contact the patient’s endocrinologist for advice if serum transaminases and/or serum creatinine levels are of concern.

Pre-filled pen 75mg, 150mg, 300mg

Solution for injection pre-filled pen 140mg

Prevention of cardiac events in patients with CHD and a history of ACS, in combination with a statin

Tablets 180mg/10mg

Tablets 180mg

Where ezetimibe is not tolerated, Bempedoic acid may be used as monotherapy.

Capsules 998 mg 

Solution for injection pre-filled syringes  284mg/1.5ml

Restricted to use in line with LSCMMG: Lipid Management Pathway for Secondary Prevention of Cardiovascular Disease (CVD).

Included in NHS England HCD list to facilitate prescribing in secondary care until primary care prescribing is established.

NHSE has introduced funding arrangements to allow prescribing in Primary Care for a nominal amount, see link below.

Capsules 5mg, 10mg, 20mg

Under expert supervision

Concentrate for solution for infusion vials 345mg/2.3ml

Solution for Injection 3%, 1%, 0.5%, 0.2%