Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
NitratesGlyceryl trinitrate (GTN) pump spray 400mcg: £1.67 (200 dose)
400mcg: £1.57 (180 dose)
Glyceryl trinitrate is included in the formulary for:
Angina: for as required use for relief of symptoms
Note that GTN tablets are now significantly more costly than spray, and aerosol spray is twice price of spray pump
Isosorbide mononitrate Instant release
10mg: £6.97 (56)
20mg: £3.28 (56)
40mg: £6.01 (56)
Isosorbide Mononitrate is included in the formulary for:
Angina: for prophylaxis of symptoms as monotherapy where intolerance or C/I to use of a beta-blocker or rate-limiting CCB. As combination therapy with beta-blocker or CCB where monotherapy provides insufficient control.

First line is to prescribe standard Isosorbide mononitrate tablets asymmetrically to ensure a nitrate free period is maintained to reduce nitrate tolerance e.g. 20mg bd at 6-8am and 2-4pm.
Sustained-release
as Tardisc XL®

or Monomil XL®
60mg tablets: £3.49 (28)

60mg tablets: £3.49 (28)

If patients cannot comply with this regime, MR preparations should be prescribed by brand (Tardisc XL® OR Monomil XL® for 60mg) and only given once-daily to reduce nitrate tolerance.
Where Isosorbide mononitrate has been added to provide symptom control pending angioplasty or CABG, consideration should be given to cautious withdrawal after successful completion of and recovery from the procedure


ISOSORBIDE DINITRATE is NON FORMULARY except where initiated by a specialist for left ventricular failure
Calcium channel blockers – Dihydropyridines
First line:Amlodipine



Lacidipine
5mg tablets: £0.73
10mg tablets: £0.78


2mg tab, 28=£2.58 (NCSO)
4mg tab, 28=£3.10 (NCSO)
NB. Avoid short-acting dihydropyridines in BP, CHD and CCF.
Amlodipine is first line CCB, with lercanidipine as a second line option for:
Hypertension: in line with NICE guidance
• Angina: as monotherapy where intolerance or C/I to use of a beta-blocker or rate-limiting CCB. As combination therapy with beta-blocker where monotherapy provides insufficient control.
NB: When prescribing Amlodipine generically, this should be as plain Amlodipine. Prescriptions for Amlodipine besilate will result in the supply of Istin® and incur significantly greater costs.
Second line:Lercanidipine10mg tablets: £4.68
20mg tablets: £5.67
Calcium channel blockers - Rate limiting
Prescribe by brandDiltiazem
Modified-release
as Zemtard XL®
Once daily dose

120mg m/r capsules: £5.19
180mg m/r capsules: £5.27
240mg m/r capsules: £5.36
300mg m/r capsules: £5.70
Diltiazem MR (as Zemtard XL®) is included in the formulary for:
• Angina: as monotherapy where intolerance or C/I to use of a beta-blocker. In combination with a beta-blocker where monotherapy provides insufficient control. NB: Caution required due to risk of bradycardia and heart-block.
Hypertension: For treatment of resistant hypertension at Step 4 where BP remains sub-optimally controlled despite standard therapies.
NB. Prescribing Diltiazem MR as the formulary preferred Zemtard XL® brand ensures continuity of supply, as recommended nationally.
Prescribe by brandVerapamil
Immediate-release

Modified-release
Half-Securon SR®
Securon SR®
40mg tablets: £1.76 (84)
80mg tablets: £2.01 (84)


120mg m/r tablets: £7.71
240mg m/r tablets: £5.55
Verapamil should not be combined with a beta-blocker for any indication due to high risk of bradycardia and heart-block

Verapamil is included in the formulary for:
• Angina: as monotherapy where intolerance or C/I to use of a beta-blocker.
Hypertension: For treatment of resistant hypertension at Step 4 where BP remains sub-optimally controlled despite standard therapies.